Morgan and Mikhail's Clinical Anesthesiology Questions
With Complete Solutions
______ and ______ can be added to local anesthetics to augment
analgesia through activation of alpha-2 receptors. Correct
Answers Epinephrine and clonidine
______ Potent, _____ lipid soluble local anesthetics generally
have a faster onset of action. Correct Answers *Less potent,
less lipid soluble* local anesthetics (lidocaine, mepivacaine)
generally have a *faster* onset of action
*More potent, more lipid-soluble* agents (ropvacaine,
bupivacaine) generally have a *slower* onset of action.
________ binds to CYP 450 and reduces metabolism of
diazepam. Correct Answers Cimetidine (acid reflex/pepcid
ulcer drug)
_________ inhibits metabolism of midazolam and causes a 2-3
fold prolongation and intensification of its effects Correct
Answers Erythromycin
__________ is used to reverse non-depolarizing neuromuscular
block from gantacurium, an ultrashort-acting neuromuscular
blocker. Correct Answers L-cysteine
***Exogenous administration of L-cysteine (10-50 mg/kg IV)
reverses the block within 2-3 minutes.
,___________ produces a secondary peak in diazepam plasma
concentrations 6-12 hrs following administration? Correct
Answers enterohepatic circulation
_______, the metabolite of fentanyl, can be measured in urine
long after the native compound is no linger detectable in blood
to determine chronic fentanyl ingestion. Correct Answers
Norfentanyl
***Great clinical importance in diagnosing fentanyl abuse.
- A core temp < ___ degrees C has an anesthetic effect and
greatly potentiates the actions of CNS depressants. Correct
Answers 33 degrees C
*Critical aortic stenosis *exists when the aortic valve orifice is
reduced to ___ to ____ cm^2 Correct Answers Critical aortic
stenosis = 0.5-0.7 cm^2
NORMAL is 2.5-3.5 cm^2
Patients with end-stage aortic stenosis classically have the triad
of heart failure, angina, and syncope.
*ENDOCRINE* effects of etomidate? Correct Answers -
Induction doses of etomidate transiently inhibit enzymes
involved in *cortisol* and *aldosterone* synthesis
- When *etomidate infusion* is used for sedation in the ICU, it
produces *consistent adrenocortical suppression* with an
,*increased mortality rate* in critically ill (particularly septic)
patients.
*Hemodynamically stable V-tach* is often terminated with a
synchronized cardioversion shock of how many Joules? Correct
Answers 25-50 J
*Perioperative management of pts on anti-coagulation:*
- Low risk for thrombosis (i.e. pts with bileaflet mechanical
valve in the aortic position with no additional problems)?
- Increased risk for thrombosis?
- Management in cases where emergent surgery is required?
Correct Answers *Pts at low risk for thrombosis:* Discontinue
warfarin 48-72 hrs preoperatively so that INR falls below 1.5
*Pts at increased risk of thrombosis:* Discontinue warfarin and
start heparin (unfractionated, or LMW) when INR falls below
2.0. Heparin can be discontinued 4-6 hrs prior to surgery and
then restarted as soon as surgical bleeding permits, until pt can
be restarted on warfarin therapy.
*Emergency situations:* FFP or PCC can be given to interrupt
warfarin therapy.
*Pre-load reduction* makes *nitroglycerine* an excellent drug
for the relief of what pulmonary condition? Correct Answers
*Cardiogenic pulmonary edema*
, 2 Classes of drug that potentiate the analgesia produced by
epidural and spinal local anesthetics? Correct Answers
Opioids
Alpha-2 agonists (clonidine)
2 possible causes of halothane hepatitis? Correct Answers
Allergic reaction (some antibodies bind to hepatocytes
previously exposed to halothane)
Combination of pre-treatment with an enzyme inducer
(phenobarbital) and then exposure to hypoxic conditions --
damage is caused by reductive metabolites of halothane, or
hypoxia.
2 ways in which cholinesterase inhibitors *prolong* the
depolarizing blockade of succinylcholine? Correct Answers 1.
Increase in acetylcholine (which increases motor end plate
depolarization)
2. inhibition of pseudocholinesterase activity
3 conditions that can cause ketoacidosis? Correct Answers
DKA
Starvation
Alcoholic binges
3 factors that affect the time to fully reverse a non-depolarizing
block? Correct Answers - The choice and dose of
cholinesterase inhibitor administered
- The muscle relaxant being antagonized
- The extent of the blockade before reversal
With Complete Solutions
______ and ______ can be added to local anesthetics to augment
analgesia through activation of alpha-2 receptors. Correct
Answers Epinephrine and clonidine
______ Potent, _____ lipid soluble local anesthetics generally
have a faster onset of action. Correct Answers *Less potent,
less lipid soluble* local anesthetics (lidocaine, mepivacaine)
generally have a *faster* onset of action
*More potent, more lipid-soluble* agents (ropvacaine,
bupivacaine) generally have a *slower* onset of action.
________ binds to CYP 450 and reduces metabolism of
diazepam. Correct Answers Cimetidine (acid reflex/pepcid
ulcer drug)
_________ inhibits metabolism of midazolam and causes a 2-3
fold prolongation and intensification of its effects Correct
Answers Erythromycin
__________ is used to reverse non-depolarizing neuromuscular
block from gantacurium, an ultrashort-acting neuromuscular
blocker. Correct Answers L-cysteine
***Exogenous administration of L-cysteine (10-50 mg/kg IV)
reverses the block within 2-3 minutes.
,___________ produces a secondary peak in diazepam plasma
concentrations 6-12 hrs following administration? Correct
Answers enterohepatic circulation
_______, the metabolite of fentanyl, can be measured in urine
long after the native compound is no linger detectable in blood
to determine chronic fentanyl ingestion. Correct Answers
Norfentanyl
***Great clinical importance in diagnosing fentanyl abuse.
- A core temp < ___ degrees C has an anesthetic effect and
greatly potentiates the actions of CNS depressants. Correct
Answers 33 degrees C
*Critical aortic stenosis *exists when the aortic valve orifice is
reduced to ___ to ____ cm^2 Correct Answers Critical aortic
stenosis = 0.5-0.7 cm^2
NORMAL is 2.5-3.5 cm^2
Patients with end-stage aortic stenosis classically have the triad
of heart failure, angina, and syncope.
*ENDOCRINE* effects of etomidate? Correct Answers -
Induction doses of etomidate transiently inhibit enzymes
involved in *cortisol* and *aldosterone* synthesis
- When *etomidate infusion* is used for sedation in the ICU, it
produces *consistent adrenocortical suppression* with an
,*increased mortality rate* in critically ill (particularly septic)
patients.
*Hemodynamically stable V-tach* is often terminated with a
synchronized cardioversion shock of how many Joules? Correct
Answers 25-50 J
*Perioperative management of pts on anti-coagulation:*
- Low risk for thrombosis (i.e. pts with bileaflet mechanical
valve in the aortic position with no additional problems)?
- Increased risk for thrombosis?
- Management in cases where emergent surgery is required?
Correct Answers *Pts at low risk for thrombosis:* Discontinue
warfarin 48-72 hrs preoperatively so that INR falls below 1.5
*Pts at increased risk of thrombosis:* Discontinue warfarin and
start heparin (unfractionated, or LMW) when INR falls below
2.0. Heparin can be discontinued 4-6 hrs prior to surgery and
then restarted as soon as surgical bleeding permits, until pt can
be restarted on warfarin therapy.
*Emergency situations:* FFP or PCC can be given to interrupt
warfarin therapy.
*Pre-load reduction* makes *nitroglycerine* an excellent drug
for the relief of what pulmonary condition? Correct Answers
*Cardiogenic pulmonary edema*
, 2 Classes of drug that potentiate the analgesia produced by
epidural and spinal local anesthetics? Correct Answers
Opioids
Alpha-2 agonists (clonidine)
2 possible causes of halothane hepatitis? Correct Answers
Allergic reaction (some antibodies bind to hepatocytes
previously exposed to halothane)
Combination of pre-treatment with an enzyme inducer
(phenobarbital) and then exposure to hypoxic conditions --
damage is caused by reductive metabolites of halothane, or
hypoxia.
2 ways in which cholinesterase inhibitors *prolong* the
depolarizing blockade of succinylcholine? Correct Answers 1.
Increase in acetylcholine (which increases motor end plate
depolarization)
2. inhibition of pseudocholinesterase activity
3 conditions that can cause ketoacidosis? Correct Answers
DKA
Starvation
Alcoholic binges
3 factors that affect the time to fully reverse a non-depolarizing
block? Correct Answers - The choice and dose of
cholinesterase inhibitor administered
- The muscle relaxant being antagonized
- The extent of the blockade before reversal
