question

Normal pediatric HR range

answer

Newborn = 120-180 6 months = 140-160 12 months = 90-150 2-3 years = 80-130 4-6 years = 80-120 6-8 years = 75-110 10-12 years = 70-110 14-16 years - 60-105

question

Average weight by child's age

answer

8yrs = 3 x age

question

Anesthetic management of AS/ MS

answer

AS: maintain sinus rhythm, HR 60-90, keep intravascular volume full. Stroke volume is often essentially fixed; hence CO is rate-dependent MS: avoid tachycardia or increased CO; keep fluids carefully balanced CVP: prominent a waves, decreased y descent

question

Normal physiology of pregnancy

answer

Heme: 20% increase in red cell mass, 45% increase in plasma volume CV: 20% decrease in SVR, 25% increase in HR, 25% increase in SV Pulm: 20% decrease in FRC, basal PaCO2 ~31mmHg after 1st trimester Renal: renal blood flow and GFR increase

question

Which drugs cross the placenta

answer

Muscle relaxants and glycopyrrolate DO NOT cross; all other drugs that we use do cross readily Local anesthetics can undergo ion trapping in the fetal circulation, resulting in fetal>>maternal plasma concentration

question

Fast track recovery

answer

Patient goes directly to Phase 2 recovery

question

Calculate CBF / CPP

answer

CBF: (MAP-ICP) / cerebral vascular resistance - OR 15-20% of cardiac output (~750 ml/minute) CPP: MAP - CVP or ICP, whichever is greater

question

Rank neural monitoring techniques in terms of susceptibility to volatile anesthetic

answer

Volatiles decrease amplitude and increase latency Most affected: visual evoked potentials Least affected: brainstem auditory evoked potentials

question

Most common cause of bleeding post-CPB?

answer

Platelet dysfunction

question

Differential diagnosis of abdominal compartment syndrome

answer

Abdominal trauma Fluid resuscitation >3L Pancreatitis Perforated peptic ulcer Pelvic fracture Ruptured AAA Cirrhosis Meigs syndrome

question

Match the medicine with the ASRA guidelines for neuraxial techniques in the setting of anticoagulation (note: preference given to American over European guidelines when they differ) - Argatroban/bivalirudin - Fondapurinox - IV UFH - Plavix - Single-daily-dose LWMH - Therapeutic-dose LMWH - Thrombolytics - Warfarin Safe interval between last dose and catheter placement: - 7 days - 4 hours (resume heparin 1 hour after) - 10-12 hours - 24 hours - Normal INR - 36 hours for single-shot - Avoid neuraxial techniques - Absolute contraindication to neuraxial techniques

answer

Safe interval between last dose and catheter placement: Plavix: 7 days IV UFH: - 4 hours (resume heparin 1 hour after) Single-daily-dose LWMH: 10-12 hours Therapeutic-dose LMWH: 24 hours Warfarin: Normal INR Fondapurinox: 36 hours for single-shot Argatroban/bivalirudin: Avoid neuraxial techniques Thrombolytics: Absolute contraindication to neuraxial techniques

question

Calculate APGAR (scores of 0 are self-evident)

answer

Appearance: 1. body pink, extremities blue 2. all pink Pulse: 1. 100 Grimace: 1. grimace 2. crying Activity 1. some fle:xion 2. active motion Respiratory effort: 1. slow, irregular 2. good (and/or crying)

question

CVP waveforms and how different conditions alter them (matching) 1) a wave 2) c wave 3) v wave 4) x wave 5) y wave A) atrial systole - absent in AF - cannon a waves in A-V dissociation B) RV contraction - elevated in TR C) venous return D) retraction of tricuspid during RV ejection - elevated in TR E) AV valve opens again - absent in tamponade

answer

a wave = atrial systole - absent in AF - cannon a waves in A-V dissociation c wave = RV contraction - elevated in TR v wave = venous return x descent = retraction of tricuspid during RV ejection - elevated in TR y descent = AV valve opens again - absent in tamponade

question

Syndromes (matching) 1) Down's 2) Goldenhar 3) Beckwith-Wiedemann 4) Pierre-Robin 5) VACTERL A) Short neck, small mouth, narrow nasopharynx, large tongue, +/- cardiac defects, +/- hypothyroidism, +/- atlanto-axial instability B) a partially formed or totally absent ear, thechin may be closer to the affected ear, onecorner of the mouth may be higher than the other, benign growths of the eye, a missing eye C) Omphalocele, organomegaly, macrosomia, large fontanelles, macroglossia, polycythemia,hypoglycemia D) Micrognathia, posterior displacement or retraction of the tongue (glossoptosis), airway obstruction, cleft palate E) Vertebral anomalies, imperforate Anus, Congenital heart disease, TracheoEsophageal fistula,Renal abnormalities, Limb abnormalities

answer

Down's Short neck, small mouth, narrow nasopharynx, large tongue, +/- cardiac defects, +/- hypothyroidism, +/- atlanto-axial instability Goldenhar a partially formed or totally absent ear, the chin may be closer to the affected ear, one corner of the mouth may be higher than the other, benigngrowths of the eye, a missing eye Beckwith-Wiedemann Omphalocele, organomegaly, macrosomia, large fontanelles, macroglossia, polycythemia, hypoglycemia Pierre-Robin Micrognathia, posterior displacement or retraction of the tongue (glossoptosis), airway obstruction, cleft palate VACTERL Vertebral anomalies, imperforate Anus, Congenital heart disease, TracheoEsophageal fistula, Renal abnormalities, Limb abnormalities

question

Lange definitions of pain terms (matching) 1) Pain 2) Neuropathic pain 3) Allodynia 4) Anesthesia dolorosa 5) Dysesthesia 6) Hyperpathia 7) Paresthesia A) an unpleasant sensory and emotional experience associated with actual or potential tissue damage B) injury or acquired abnormality of peripheral or central nervous system structures C) perception of an ordinarily non-noxious stimulus as pain D) pain in an area that lacks sensation E) unpleasant or abnormal sensation with or without a stimulus F) hyperesthesia+allodynia+hyperalgesia, persisting after the stimulus is gone G) abnormal sensation without a perceived stimulus

answer

Pain: an unpleasant sensory and emotional experience associated with actual or potential tissue damage Neuropathic pain: injury or acquired abnormality of peripheral or central nervous system structures Allodynia: perception of an ordinarily non-noxious stimulus as pain Anesthesia dolorosa: pain in an area that lacks sensation Dysesthesia: unpleasant or abnormal sensation with or without a stimulus Hyperpathia: hyperesthesia+allodynia+hyperalgesia, persisting after the stimulus is gone Paresthesia: abnormal sensation without a perceived stimulus

question

Calculate Hunt & Hess score for head injury

answer

???

question

Pain of spinal stenosis is made worse by

answer

Walking downhill

question

Wrist fracture 6 months prior; X-ray shows no bony injury; arm is cool, edematous, with allodynia

answer

CRPS

question

What is a symptom of correctly performed celiac plexus block?

answer

Diarrhea

question

What is a symptom of correctly performed stellate ganglion block?

answer

Ptosis

question

What is the treatment for CRPS of the arm?

answer

Stellate ganglion block

question

1st-line treatment for local anesthetic toxicity?

answer

Lipid emulsion

question

What causes the three kinds of fetal cardiac decelerations?

answer

???

question

Signs/symptoms of pre-eclampsia?

answer

???

question

Diagnostic criteria for ARDS?

answer

???

question

Treatment of ruptured cerebral aneurysm?

answer

???

question

Best therapy for decreasing ICP post-op in the awake patient s/p frontal crani?

answer

???

question

Best therapy for preventing VAP?

answer

HOB 30 degrees?

question

Signs/symptoms critical aortic stenosis?

answer

???

question

Calculate SVR

answer

???

question

Calculate GCS

answer

???

question

Best treatment to keep open PDA?

answer

???

question

Best management for tetralogy of Fallot?

answer

???

question

Meconium-stained infant born one minute ago, bulb suction of nose and mouth performed, still with weak respirations, what is your next step?

answer

???

question

Pt 3 days s/p esophagoggastrectomy for esophageal CA, received epidural for pain management, now has dyspnea/tacypnea: most likely cause?

answer

???

question

Magnesium therapy for pre-eclampsia: therapeutic dose, dose to ablate DTRs, side effects?

answer

???

question

Pt with QT 550 is most at risk for what arrhythmia?

answer

Torsades

question

Spinal cord stimulator is most clearly indicated in which of the following conditions: A) Postherpetic neuralgia B) Radiculopathy post laminectomy C) Distractor, distractor, distractor

answer

???

question

What neurotransmitter mediates pain signaling at primary afferent neurons? A) Dynorphin B) Glutamate C) Dopamine D) Epinephrine

answer

???

question

First line pressor in septic shock?

answer

Norepinephrine

question

Pt with CO of 5L/min based on Fick equation using assumed oxygen consumption, simultaneously CO of 12 L/min via thermodilution. What is your next move?

answer

- Start broad spectrum Abx for septic shock - Obtain TEE to verify CO - CXR to check pulmonary catheter placement

question

With which condition should you NOT use isoflurane? A) Central core syndrome B) Myasthenia gravis C) Spinal ataxia D) Distractor

answer

???

question

5 kg Pediatric patient has SVT. The dose for monophasic cardioversion is? A) 30 joules B) 200 joules C) 15 joules D) 50 joules

answer

???

question

What might you see in a patient who is s/p a bilateral CEA, that you might not see after a unilateral CEA?

answer

- Lack of baroreceptor response - Elevated PaCO2

question

C-section is being performed, and the fetal head is trapped in the uterus. What drug should be given?

answer

Terbutaline

question

Kid with foreign body in the airway - what is the best management?

answer

Inhalational induction

question

35 y/o drug user with BP 90/30, new onset 4/6 murmur at left sternal border, what lesion does he have?

answer

Acute MR

question

Pt with primary pulmonary HTN, in which inhaled nitric oxide is abruptly discontinued - what would you expect to see?

answer

Decrease in cardiac output?

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