Anesthesiology Advanced Exam July 2024
nerve stimulation causes foot plantar flexion and inversion - CORRECT ANSWER-tibial nerve
-- are recommended as first-line therapy for SVT (narrow complex tachycardia). - CORRECT
ANSWER-Vagal maneuvers and/or adenosine
If adenosine is ineffective or IV/IO access is not available, then proceed with synchronized
cardioversion
-- are the main risks to personnel chronically exposed to ionizing radiation. - CORRECT
ANSWER-Cataracts and cancer
The risk of cataracts and cancer can be reduced by using protective lead eyeware and lead
coverings.
-- is an effective modality in pain management of post-thoracotomy pain and can be especially
useful in patients in whom neuraxial anesthesia is contraindicated. With regards to patients on
antithrombotic agents, paravertebral blocks follow the same guidelines as neuraxial anesthesia. -
CORRECT ANSWER-TENS (transcutaneous electrical nerve stimulation (TENS) unit)
-- is an initial treatment option for the euvolemic neonate in response to hypotension. -
CORRECT ANSWER-atropine
The autonomic nervous system of newborns is not mature. It is characterized by low
catecholamine stores and poor responsiveness to exogenous catecholamines. Conversely, the
parasympathetic nervous system is intact in newborns and predominates. For this reason,
bradycardia or hypotension in neonates is typically very responsive to atropine,
-- is effective for prophylaxis against symptoms of acute mountain sickness (AMS). - CORRECT
ANSWER-Acetazolamide (a carbonic anhydrase inhibitor) as it augments the hypoxic
ventilatory response promoting urinary bicarbonate loss
also consider staged ascent
-- is the first-line treatment for relaxation of the uterus. It can be administered via sublingual
spray or intravenous push injection (low dose) - CORRECT ANSWER-nitroglycerin
-- is the most likely and most appropriate therapy to terminate unstable supraventricular
tachycardia in a transplanted heart - CORRECT ANSWER-Synchronized cardioversion
Carotid sinus stimulation and other indirect therapies will have limited efficacy in a denervated,
transplanted heart. Cardioversion is the therapy of choice for supraventricular tachycardia in
these patients, especially if it results in hemodynamic instability.
-- is the MOST likely of the local anesthetic options to undergo ion trapping and potentially
accumulate in the fetus during fetal acidosis. - CORRECT ANSWER-Lidocaine 2%
ion trapping may be more relevant during multiple epidural boluses of lidocaine 2% when the
epidural catheter is intravascular, particularly if lidocaine is then used for a subsequent RSI.
-- is the primary pharmacologic treatment of acromegaly as it suppresses growth hormone
production. - CORRECT ANSWER-Octreotide
-- is the treatment of choice for management of surgical bleeding in patients with type 1 vWD. -
CORRECT ANSWER-desmopressin (DDAVP)
,-- is useful in patients with type 1 vWD who fail to adequately respond to desmopressin, are
undergoing major surgery, or in the setting of severe bleeding. - CORRECT ANSWER-Factor
VIII-vWF concentrate
-- seen in DMD patients increases their risk of aspiration with general anesthesia. - CORRECT
ANSWER-Delayed gastric emptying along with impaired laryngeal reflexes
3 mL of 2% lidocaine is injected into the base of the palatoglossal fold. which nerve is
anesthetized? - CORRECT ANSWER-glossopharyngeal nerve
6 to 12-μm myelinated fibers that carry touch sensation at conduction speeds of 35 to 90 m/sec. -
CORRECT ANSWER-A beta fibers
A BPF (bronchopleural fistula) is one of the absolute indications for a DLT and lung isolation.
Other absolute indications include: - CORRECT ANSWER-- Isolation for infectious material
such as during a bronchopulmonary lavage
- Isolation for hemorrhage
- Isolation for pulmonary alveolar proteinosis
- Tracheobronchial tree disruption
- Bullae
- Broncho-cutaneous fistula
A certificate issued by the American Board of Anesthesiology (ABA) is subject to revocation if
the person certified: - CORRECT ANSWER-- violated any rule or regulation of the board
- was found not to have been eligible to receive the certificate originally
- made any misstatement or omission of fact in their registration
- failed to maintain a satisfactory professional standing.
A classic triad of symptoms has been described for fat embolism syndrome consisting of: -
CORRECT ANSWER-- petechiae (mostly around the head, neck, and axillae),
- hypoxemia,
- neurologic abnormalities (e.g., altered level of consciousness or seizure)
Signs and symptoms usually develop within 12-40 hours after the initial insult.
A cuff-leak volume (difference between the inspired and expired tidal volume) of --- predicts a
patient at increased risk for airway compromise from edema - CORRECT ANSWER-either
<24% of inspired volume or an absolute value <130 mL
A deep cervical plexus block may cause blockade of the --, causing diaphragmatic paresis and
ipsilateral hemidiaphragmatic elevation. - CORRECT ANSWER-phrenic nerve
A foot dorsiflexion and eversion twitch indicates stimulation of the-- nerve - CORRECT
ANSWER-common peroneal nerve
A long-term adaptation (weeks) to hypoxemia at altitude include: - CORRECT ANSWER-
increased hemoglobin concentration from increased erythropoietin secretion
Over the following 1-3 weeks, continued (relative) renal hypoxia will trigger the increased renal
secretion of erythropoietin. This begins to increase hemoglobin concentration and improves the
oxygen-carrying capacity of blood and oxygen delivery to tissues.
A mnemonic for the causes of a decrease in FRC is PANGOS: - CORRECT ANSWER-
Pregnancy, Ascites, Neonates, General anesthesia, Obesity, Supine position.
A mnemonic to help with electrolyte changes with the electrocardiogram is "hyPeR", where: -
CORRECT ANSWER-hyperkalemia/calcemia/magnesemia leads to PRolongation of the PR
interval. The opposite tends to occur with the QT interval for each electrolyte.
,A mutation in the inwardly rectifying potassium channel is the cause of what syndrome? -
CORRECT ANSWER-Andersen-Tawil syndrome.
A myotonic episode can be treated with: - CORRECT ANSWER-- phenytoin,
- quinine,
- procainamide,
- direct infiltration of the affected muscle with local anesthetic,
- or a high concentration of volatile anesthetic
A neonate has persistent cyanosis and heart rate less than 100 beats per minute (bpm). Drying
and stimulation have already been performed. what is the next step in management? -
CORRECT ANSWER-positive pressure ventilation
- Provide oxygen if the neonate continues to have signs of cyanosis and provide positive pressure
ventilation if the neonate has a heart rate less than 100 bpm.
- If the heart rate is less than 60 bpm, add chest compressions in a 3:1 ratio.
- Intravenous epinephrine can be considered if these measures fail to adequately resuscitate the
neonate.
A normal central venous pressure reading is - CORRECT ANSWER-between 8 to 12 mmHg
A patient in labor who is taking buprenorphine for opioid use disorder is requesting an epidural
for labor pain. Which of the following statements regarding buprenorphine and labor analgesia is
TRUE? - CORRECT ANSWER-Dividing the usual daily dose of buprenorphine maximizes its
analgesic properties and may be useful in addition to other analgesic options during labor and the
postpartum period. The dose may be divided from once daily to up to four times per day.
women taking buprenorphine have similar pain scores and analgesic requirements during labor
but experience more postpartum pain compared with matched controls. For the treatment of
short-term moderate pain, in addition to dividing the dose, the dose may be increased up to 32
mg per day.
A patient with a magnet applied to his implantable cardioverter-defibrillator develops a life-
threatening arrhythmia intraoperatively. What is the next BEST step in treatment of this patient?
- CORRECT ANSWER-the magnet should be removed to allow the device to deliver the shock
If this is unsuccessful, emergency external defibrillation pads should be applied for external
cardioversion.
a patient with Becker's muscular dystrophy has a hyperkalemic cardiac arrest after receiving
succinylcholine. Which of the following BEST describes the mechanism for the hyperkalemia? -
CORRECT ANSWER-breakdown of skeletal muscle tissue (aka rhabdomyolysis)
In muscular dystrophy, succinylcholine-induced hyperkalemia is due to rhabdomyolysis.
A pheochromocytoma is a catecholamine-secreting tumor arising from the --. The tumors
generally secrete --- - CORRECT ANSWER-- adrenal medulla
- norepinephrine, epinephrine, and dopamine
A review of the American College of Surgeons National Surgical Quality Improvement Program
(ACS-NSQIP) has found which factors to be associated with higher rates of postoperative
pulmonary complications following major abdominal surgery? - CORRECT ANSWER--
dependent preoperative functional status
- ASA class III or IV
, - prolonged operative time,
- age greater than 60
- severe chronic obstructive pulmonary disease (COPD)
- smoking
- male gender
- low BMI
A sudden decrease in EtCO2 and SpO2 after tourniquet release should raise suspicion for ? -
CORRECT ANSWER-a pulmonary embolus from a preoperative DVT
A useful mnemonic to help remember perioperative conditions leading to sickling:SIX H's cause
SICKling (HbS) - CORRECT ANSWER-1. Hypothermia
2. Hyperthermia
3. Hypoxemia
4. Hypotension
5. Hypovolemia
6. H+ ions (acidosis)
Absolute contraindications to MIDCAB include -- - CORRECT ANSWER-- subclavian artery
occlusion (it precludes the use of the LIMA for anastomosis bc the LIMA branches off from the
subclavian artery)
- cardiogenic shock due to acute LAD occlusion (MIDCAB requires more time for surgical
exposure so this situation is not safe)
Absolute contraindications to TEE probe placement are: - CORRECT ANSWER-- perforated
viscus,
- esophageal stricture (ex scleroderma)
- esophageal tumor,
- esophageal tear,
- esophageal (zenker) diverticulum,
- active upper GI bleed (ex mallory weiss tear)
- perforated viscous
Absolute indications for parenteral therapy (TPN) include: - CORRECT ANSWER-- short gut
syndrome,
- small bowel obstruction,
- active gastrointestinal bleeding,
- pseudo-obstruction with complete intolerance to food,
- high output enterocutaneous fistulas (> 500 ml/day) (unless a feeding tube can be passed distal
to the fistula)
acetazolamide moa and resultant metabolic changes? acidosis vs alkalosis? - CORRECT
ANSWER-Acetazolamide is a potent inhibitor of carbonic anhydrase, which results in wasting of
sodium and bicarbonate in the proximal tubule, with subsequent diuresis and also alkalinization
of the urine. This results in a hyperchloremic metabolic acidosis.
note, Carbonic anhydrases normally catalyze a reaction for the bidirectional conversion of
carbon dioxide (CO2) and water (H2O) into bicarbonate (HCO3-) and protons (H+).
Acetazolamide works to cause an accumulation of carbonic acid by preventing its breakdown.
The result is lower blood pH (i.e., more acidic), given the increased carbonic acid, which has a
reversible reaction into bicarbonate and a hydrogen ion.
nerve stimulation causes foot plantar flexion and inversion - CORRECT ANSWER-tibial nerve
-- are recommended as first-line therapy for SVT (narrow complex tachycardia). - CORRECT
ANSWER-Vagal maneuvers and/or adenosine
If adenosine is ineffective or IV/IO access is not available, then proceed with synchronized
cardioversion
-- are the main risks to personnel chronically exposed to ionizing radiation. - CORRECT
ANSWER-Cataracts and cancer
The risk of cataracts and cancer can be reduced by using protective lead eyeware and lead
coverings.
-- is an effective modality in pain management of post-thoracotomy pain and can be especially
useful in patients in whom neuraxial anesthesia is contraindicated. With regards to patients on
antithrombotic agents, paravertebral blocks follow the same guidelines as neuraxial anesthesia. -
CORRECT ANSWER-TENS (transcutaneous electrical nerve stimulation (TENS) unit)
-- is an initial treatment option for the euvolemic neonate in response to hypotension. -
CORRECT ANSWER-atropine
The autonomic nervous system of newborns is not mature. It is characterized by low
catecholamine stores and poor responsiveness to exogenous catecholamines. Conversely, the
parasympathetic nervous system is intact in newborns and predominates. For this reason,
bradycardia or hypotension in neonates is typically very responsive to atropine,
-- is effective for prophylaxis against symptoms of acute mountain sickness (AMS). - CORRECT
ANSWER-Acetazolamide (a carbonic anhydrase inhibitor) as it augments the hypoxic
ventilatory response promoting urinary bicarbonate loss
also consider staged ascent
-- is the first-line treatment for relaxation of the uterus. It can be administered via sublingual
spray or intravenous push injection (low dose) - CORRECT ANSWER-nitroglycerin
-- is the most likely and most appropriate therapy to terminate unstable supraventricular
tachycardia in a transplanted heart - CORRECT ANSWER-Synchronized cardioversion
Carotid sinus stimulation and other indirect therapies will have limited efficacy in a denervated,
transplanted heart. Cardioversion is the therapy of choice for supraventricular tachycardia in
these patients, especially if it results in hemodynamic instability.
-- is the MOST likely of the local anesthetic options to undergo ion trapping and potentially
accumulate in the fetus during fetal acidosis. - CORRECT ANSWER-Lidocaine 2%
ion trapping may be more relevant during multiple epidural boluses of lidocaine 2% when the
epidural catheter is intravascular, particularly if lidocaine is then used for a subsequent RSI.
-- is the primary pharmacologic treatment of acromegaly as it suppresses growth hormone
production. - CORRECT ANSWER-Octreotide
-- is the treatment of choice for management of surgical bleeding in patients with type 1 vWD. -
CORRECT ANSWER-desmopressin (DDAVP)
,-- is useful in patients with type 1 vWD who fail to adequately respond to desmopressin, are
undergoing major surgery, or in the setting of severe bleeding. - CORRECT ANSWER-Factor
VIII-vWF concentrate
-- seen in DMD patients increases their risk of aspiration with general anesthesia. - CORRECT
ANSWER-Delayed gastric emptying along with impaired laryngeal reflexes
3 mL of 2% lidocaine is injected into the base of the palatoglossal fold. which nerve is
anesthetized? - CORRECT ANSWER-glossopharyngeal nerve
6 to 12-μm myelinated fibers that carry touch sensation at conduction speeds of 35 to 90 m/sec. -
CORRECT ANSWER-A beta fibers
A BPF (bronchopleural fistula) is one of the absolute indications for a DLT and lung isolation.
Other absolute indications include: - CORRECT ANSWER-- Isolation for infectious material
such as during a bronchopulmonary lavage
- Isolation for hemorrhage
- Isolation for pulmonary alveolar proteinosis
- Tracheobronchial tree disruption
- Bullae
- Broncho-cutaneous fistula
A certificate issued by the American Board of Anesthesiology (ABA) is subject to revocation if
the person certified: - CORRECT ANSWER-- violated any rule or regulation of the board
- was found not to have been eligible to receive the certificate originally
- made any misstatement or omission of fact in their registration
- failed to maintain a satisfactory professional standing.
A classic triad of symptoms has been described for fat embolism syndrome consisting of: -
CORRECT ANSWER-- petechiae (mostly around the head, neck, and axillae),
- hypoxemia,
- neurologic abnormalities (e.g., altered level of consciousness or seizure)
Signs and symptoms usually develop within 12-40 hours after the initial insult.
A cuff-leak volume (difference between the inspired and expired tidal volume) of --- predicts a
patient at increased risk for airway compromise from edema - CORRECT ANSWER-either
<24% of inspired volume or an absolute value <130 mL
A deep cervical plexus block may cause blockade of the --, causing diaphragmatic paresis and
ipsilateral hemidiaphragmatic elevation. - CORRECT ANSWER-phrenic nerve
A foot dorsiflexion and eversion twitch indicates stimulation of the-- nerve - CORRECT
ANSWER-common peroneal nerve
A long-term adaptation (weeks) to hypoxemia at altitude include: - CORRECT ANSWER-
increased hemoglobin concentration from increased erythropoietin secretion
Over the following 1-3 weeks, continued (relative) renal hypoxia will trigger the increased renal
secretion of erythropoietin. This begins to increase hemoglobin concentration and improves the
oxygen-carrying capacity of blood and oxygen delivery to tissues.
A mnemonic for the causes of a decrease in FRC is PANGOS: - CORRECT ANSWER-
Pregnancy, Ascites, Neonates, General anesthesia, Obesity, Supine position.
A mnemonic to help with electrolyte changes with the electrocardiogram is "hyPeR", where: -
CORRECT ANSWER-hyperkalemia/calcemia/magnesemia leads to PRolongation of the PR
interval. The opposite tends to occur with the QT interval for each electrolyte.
,A mutation in the inwardly rectifying potassium channel is the cause of what syndrome? -
CORRECT ANSWER-Andersen-Tawil syndrome.
A myotonic episode can be treated with: - CORRECT ANSWER-- phenytoin,
- quinine,
- procainamide,
- direct infiltration of the affected muscle with local anesthetic,
- or a high concentration of volatile anesthetic
A neonate has persistent cyanosis and heart rate less than 100 beats per minute (bpm). Drying
and stimulation have already been performed. what is the next step in management? -
CORRECT ANSWER-positive pressure ventilation
- Provide oxygen if the neonate continues to have signs of cyanosis and provide positive pressure
ventilation if the neonate has a heart rate less than 100 bpm.
- If the heart rate is less than 60 bpm, add chest compressions in a 3:1 ratio.
- Intravenous epinephrine can be considered if these measures fail to adequately resuscitate the
neonate.
A normal central venous pressure reading is - CORRECT ANSWER-between 8 to 12 mmHg
A patient in labor who is taking buprenorphine for opioid use disorder is requesting an epidural
for labor pain. Which of the following statements regarding buprenorphine and labor analgesia is
TRUE? - CORRECT ANSWER-Dividing the usual daily dose of buprenorphine maximizes its
analgesic properties and may be useful in addition to other analgesic options during labor and the
postpartum period. The dose may be divided from once daily to up to four times per day.
women taking buprenorphine have similar pain scores and analgesic requirements during labor
but experience more postpartum pain compared with matched controls. For the treatment of
short-term moderate pain, in addition to dividing the dose, the dose may be increased up to 32
mg per day.
A patient with a magnet applied to his implantable cardioverter-defibrillator develops a life-
threatening arrhythmia intraoperatively. What is the next BEST step in treatment of this patient?
- CORRECT ANSWER-the magnet should be removed to allow the device to deliver the shock
If this is unsuccessful, emergency external defibrillation pads should be applied for external
cardioversion.
a patient with Becker's muscular dystrophy has a hyperkalemic cardiac arrest after receiving
succinylcholine. Which of the following BEST describes the mechanism for the hyperkalemia? -
CORRECT ANSWER-breakdown of skeletal muscle tissue (aka rhabdomyolysis)
In muscular dystrophy, succinylcholine-induced hyperkalemia is due to rhabdomyolysis.
A pheochromocytoma is a catecholamine-secreting tumor arising from the --. The tumors
generally secrete --- - CORRECT ANSWER-- adrenal medulla
- norepinephrine, epinephrine, and dopamine
A review of the American College of Surgeons National Surgical Quality Improvement Program
(ACS-NSQIP) has found which factors to be associated with higher rates of postoperative
pulmonary complications following major abdominal surgery? - CORRECT ANSWER--
dependent preoperative functional status
- ASA class III or IV
, - prolonged operative time,
- age greater than 60
- severe chronic obstructive pulmonary disease (COPD)
- smoking
- male gender
- low BMI
A sudden decrease in EtCO2 and SpO2 after tourniquet release should raise suspicion for ? -
CORRECT ANSWER-a pulmonary embolus from a preoperative DVT
A useful mnemonic to help remember perioperative conditions leading to sickling:SIX H's cause
SICKling (HbS) - CORRECT ANSWER-1. Hypothermia
2. Hyperthermia
3. Hypoxemia
4. Hypotension
5. Hypovolemia
6. H+ ions (acidosis)
Absolute contraindications to MIDCAB include -- - CORRECT ANSWER-- subclavian artery
occlusion (it precludes the use of the LIMA for anastomosis bc the LIMA branches off from the
subclavian artery)
- cardiogenic shock due to acute LAD occlusion (MIDCAB requires more time for surgical
exposure so this situation is not safe)
Absolute contraindications to TEE probe placement are: - CORRECT ANSWER-- perforated
viscus,
- esophageal stricture (ex scleroderma)
- esophageal tumor,
- esophageal tear,
- esophageal (zenker) diverticulum,
- active upper GI bleed (ex mallory weiss tear)
- perforated viscous
Absolute indications for parenteral therapy (TPN) include: - CORRECT ANSWER-- short gut
syndrome,
- small bowel obstruction,
- active gastrointestinal bleeding,
- pseudo-obstruction with complete intolerance to food,
- high output enterocutaneous fistulas (> 500 ml/day) (unless a feeding tube can be passed distal
to the fistula)
acetazolamide moa and resultant metabolic changes? acidosis vs alkalosis? - CORRECT
ANSWER-Acetazolamide is a potent inhibitor of carbonic anhydrase, which results in wasting of
sodium and bicarbonate in the proximal tubule, with subsequent diuresis and also alkalinization
of the urine. This results in a hyperchloremic metabolic acidosis.
note, Carbonic anhydrases normally catalyze a reaction for the bidirectional conversion of
carbon dioxide (CO2) and water (H2O) into bicarbonate (HCO3-) and protons (H+).
Acetazolamide works to cause an accumulation of carbonic acid by preventing its breakdown.
The result is lower blood pH (i.e., more acidic), given the increased carbonic acid, which has a
reversible reaction into bicarbonate and a hydrogen ion.
