Endoscopic retrograde cholangiopancreatography

Positron emission tomography scan

Percutaneous transhepatic cholangiography

Hepatobiliary Iminodiacetic acid scan (HIDA)

TRUE

FALSE

Increased

Decreased

Concentrated

Normal

Grade 1

Grade 2

Grade 3

Grade 4

B12

B6

C

A

1.5kg

2.2kg

3kg

4.5kg

40%

35%

25%

50%

ZONE 4

ZONE 3

ZONE 2

ZONE 1

<20 mmhg

<30 mmhg

<40mmhg

<50mmhg

Hypovolemia

Hypokalemia

Hypoglycemia

Hypothyroidism

Muscle relaxation and analgesia

Safety and minimal bleeding

Control of IOP and occurence of OCR

Smooth emergence

Optic foramen

Superior orbital fissure

Sphenomaxillary fissure

Lacrimal floss

Iris, choroid, pupils

Iris, choroid, ciliary body

Iris, globe, retina

Iris, choriocapillary, retina

Aqueous humor flows from anterior chamber thru the papillary aperture into the posterior chamber

From the posterior chamber, aqueous humor bathes the avascular lens and once in the posterior chamber bathes the corneal endothelium

Obstruction of venous return at any point from the eye to the right side of the heart impedes aqueous drainage, elevating IOP

The osmotic pressure of aqueous humor, once at the posterior chamber, is much less than that of plasma

Decrease scleral compliance

Hardening of crystalline ions

Enlargement of crystalline lens

Liquefaction of vitreous gel

Rate of aqueous formation

Rate of aqueous outflow

Role of venous pressure and scleral rigidity

Intraocular lens

Peripheral iris moving into direct contact with the posterior corneal surface

Narrow angle between iris and posterior cornea

Decrease thickening of the peripheral iris

Swelling of crystalline lens

Overhydration

Trendelenburg position

Constriction of patients neck

Hypocapnea

Onset at 37 months

Presents with exophthalmos

Associated w/ obstructed aqueous outflow

Non-surgical eyed disease in the young

Ease of administration

Decrease in aqueous formation

Cardiac dysrythymia

Intravascular volume overload

Isotonic

Non hemolytic

Electrically inert

Transparent

All of the above

Patients remains awake

Recognition of early sign and symptoms of TURP syndrome

Avoid Incomplete block of sacral nerves

All of the above

Target level : T10 block

RASAB

Lithotomy position with slight Tredelenburg tilt

All of the above

None of the above

Height of irrigating solution above the surgical table

Amount of Distension of the bladder

Extent of opened venous sinuses

Length of surgical resection time

All of the above

Limit resection time to less 1 hour

Suspend the irrigating fluid bag not > 30 cm above the OR table at the beginning and 15 cm above in final stage

Avoid hypotonic IVF

Use of IV vasopressors in treating RA induced hypotension

All of the above

Anticipate possible injuries to major blood vessels, hemorrhage

Epidural/ Spinal anesthesia, GA, CSE + GA

Exaggerated Lithotomy position

Venous air embolism risk

All of the above

GETA

Standard monitor, adequate IV acess

Adequate depth of neuromuscular blockade

All of the above

most common to perform for urolithiasis

for intranephric stone of small to moderate size, proximal ureteral stones

less invasive

Risk for dysrhythmias

All of the above

Bleeding disorder or anticoagulation

Untreated UTI

Morbid obesity

Pacemaker, ICD, neurostimulation implant

Cement interdigitates with bone- Systemic adsorption of residual MMA

Hardening of cement and expansion against prosthesis- Vasoconstriction

Intramedullary Hypotension( < 500 mmHg)

Embolization of fat, bone marrow, cement and air into venous channels- Platelet aggregation, microthrombus formation

Decreased end tidal CO2

Hypoxia

Hypotension

Left ventricular failure and cardiac arrest.

Increasing FiO2 prior to cementing

Monitoring and maintaining hydration

Low pressure lavage of femoral shaft to remove debris

Creating a vent hole in the distal femur.

ASA II to III

Instrumented femoral canal

Mixing cement in atmosphere rather than vacuum

Venting of the femoral shaft.

1

2

3

4

Prolonged inflation (>30mins) leads to nerve injuries

Proper inflation of 100mmhg above DBP

Prolonged inflation ( >1 hour) leads to rhabdomyolysis

Prolonged inflation of (> 2 hours) leads to transient muscle dysfunction.

Parasympampathetic stimulation: marked HTN, tachycardia, diaphoresis

Venous thromboembolism, pulmonary embolism

Transient muscle dysfunction--à rhabdomyolysis

Elliminate intraoperative bleeding.

Decreases the tourniquet pain experienced

Transient respiratory acidosis

Core temperature increases

Increased blood level of: PaCO2, Sodium and chloride

Narrow, high pressure cuff

Limit the time to 2 hours

Set maximum pressure: ARM 50-75 mmHg above systolic. Leg 75-100 mmHg above systolic.

Adequate padding underneath.

FES>2-22%, all long bone fracture

Mortality rate 50%

Presents within 24 hours post op following fracture of the long bone

triad of DYSPNEA, CONFUSION, PETECHIAE

Fat globule released from disruption of fat cells in fractured bone- degeneration of free fatty acids

Enters circulation through tears in medullary vessels. Toxic effects on veno-alveolar membrane

Embolization of right heart and pulmonary capillaries- Release of vasoactive amines and PG’s

Development of ARDS, disruption of cerebral venous membrane---Cerebral edema

Thrombocystosis, Prololonged PTT

Mild Hypoxia ( 20% ARDS)

Persistent HTN

Petechiae

Major features ( at least One) Minor features ( at least four)+ HIGH ESR

Major features ( at least Two) Minor features ( at least three)+ ANEMIA

Major features ( at least Three) Minor features ( at least two)+ fat microglobinuria

Major features ( at least Four) Minor features ( at least one)+ thrombocytopenia

A score of > 6 is required

Petechial rash, Diffuse alveolar infiltrates, confusion, HR> 150

Petechial rash, Hypoxemia PaO2< 70 mmhg, FiO2 100%

Petechial rash, RR 20, confusion, Temperature of 37 degrees Celsius.

Decline in end tidal volume

Left sided heart strain on ECG

Ischemic appearing ST segment changes on ECG

Rise in pulmonary pressures.

Bone Cement Implantation Syndrome

DVT and Thromboembolism

Fat embolism syndrome

Prolonged pneumatic tourniquet compression

Pulmonary hypetension

Endothelial damage

Hypercoagulable state

Venous stasis

Immobilization> 2 hours

Obesity

Lower extremity fracture

Procedure > 30 mins

High dose heparin

Warfarin

Intermittent pneumatic compression

TED stockings.

Arterial thrombi-à Fibrin thrombi---à Thrombolytics

Severe, possible fatal PE----àThrombolytics

Warfarin: blocks Vitamin K dependent factors III,VI,IX, XI

LMWH activates thrombin and Factor Xa through an antithrombin dependent mechanism

WARFARIN, Stop 5-7 days prior to neuroaxial block, confirm Normal INR before needle insertion.

Aspirin stop for 5 – 7 days

Clopidogral Stop for 7 days. If Neuroaxial is considered between 5-7 days, restoration of platelet function must be confirmed.

Ticlopidine Stop for 7-10 days prior to Neuroaxial block.

LMWH, Preoperatively wait 10-12 hours after prophylactic dose, < 12 hours after treatment dose.

LMWH, Postoperatively: catheter removal at least 2 hours prior to initiation of twice daily dosing regiments.

LMWH SQ, 10,000 units per day or less. Check platelet count if > 4days on heparin.

LMWH IV stopped 12 hours prior to cathether removal. Wait for one hour after neuroaxial block or catheter removal before administration of drug.

Respiratory acidosis

Decreased levels of circulating catecholamines

Increased renal perfusion

Correction of precipitating causes of encephalopathy preoperatively.

Azathioprine

Prednisolone

Cyclosporine

Rapamycin

Partial thromboplastin time

Serum bilirubin

Aminotransferase activity

Liver Biopsy

En bloc double lung transplant

Heart transplant

Single lung transplant refractory to one-lung ventilation

All of the above

Physicians involved in the transplant recipient process should not be involved in declaration of brain death of a donor.

Potentially reversible causes of coma must be ruled out (hypothermia, hypotension, drugs, toxins) before declaration of brain death.

Brain-dead donors are responsive to sensory stimuli and have no brainstem reflexes, including ventilatory drive with apnea testing, but may have complex motor activity

Once pituitary failure ensues, hormone therapy may help stabilize donors hemodynamically and thereby extend the donor pool

Apnea

Dopamine ≤15mcg/kg/min (correct is ≥15mcg/kg/min)

Respiratory rate <8 or > 30 breaths/min

FiO2 ≥0.5 or SaO2≤92

The donor/ patient is placed in a lateral decubitus position on a flexible OR table with a kidney rest

An incision is made from the rectus muscle, angling slightly caudal to cross into the flank just below the tip of the 12th rib

A clamp is placed across the renal artery at the aorta and the renal vein at the IVC.

It is important to keep the vascular volume expanded in these patients before kidney removal

Hemorrhage

Increasing coagulopathy and fibrinolysis

Increase renal function and hypothermia

A and B

Age <55 years

ABO compatibility

minimal Pneumonitis on chest radiograph

Tobacco history <10 pack years

Decrease HR and decrease BP

Severe coagulopathy

Decrease SVR in the face of acutely increasing RV filling pressures

All of the Above

A. Proposed mechanism is that during inspiration before adenotonsillectomy, the positive intrapleural pressure that is generated causes a decrease in venous return, diminishing pulmonary blood volume

B. Pleural pressure in the healthy child with airway obstruction ranges from -2.5 cm to -10 cm H2O during inspiration

C. Intrapleural pressure in the healthy child without airway obstruction can be as much as -30 cm H2O during inspiration

D. The rapid relief of airway obstruction results in decreased airway pressure, an increase in venous return, an increase in pulmonary hydrostatic pressure, hyperemia, and finally pulmonary edema

E. None of the above

A. Cysts

B. Tracheomalacia

C. Laryngomalacia

D. Choanal atresia

E. Croup

A. Anatomic nasal obstruction reduce oropharyngeal cross-sectional area

B. Fibrosis and ankylosis in the temporomandibular joint

C. Anatomic imbalance between the upper airway soft tissue volume and craniofacial size

D. Pharyngeal dilator muscles do not contract maximally

E. All of the above

A. Hypertension

B. Bradycardia

C. Tachycardia

D. Arrythmias

E. All of the above

A. Passes above the floor of the nose but involves the lower third of the nasal septum

B. Crosses the medial wall of the orbit, including lacrimal bone

C. Passes through the base of the nose and the orbital plates

D. Is a horizontal fracture of maxilla

E. Always involves a fracture of the cribriform plate of the ethmoid bone.

A. They are located below the laryngeal inlet.

B. They usually interfere with ventilation by mask.

C. They usually impair vocal cord visualization.

D. They often require surgical intervention.

E. None of the above

A. A 10 year old child with Down syndrome

B. A healthy 1 year old child

C. A 7 year old child with peritonsillar abscess

D. A 15 year old patient with a mild upper respiratory infection

E. None of the above

A. Increased incidence of systemic and pulmonary hypertension.

B. Centrally mediated elevations in PCO₂.

C. Cardiac enlargement

D. Decreased myocardial sensitivity to hypoxia.

None of the above

A. Inhalation induction with sevoflurane with head down tilt.

B. Rapid sequence induction with thiopentone and suxamethonium.

C. Rapid sequence induction with thiopentone and rocuronium.

D. Rapid sequence induction with propofol and rocuronium.

E. Inhalational induction with desflurane with a head down tilt.

A. It is usually less severe when intraoperative hemostasis is achieved with laser and electrocautery rather than with sharp surgical dissection and ligation of blood vessels.

B. It is usually less severe than after adenoidectomy.

C. Its severity is often reduced when the peritonsillar space is infiltrated with local anesthetic.

D. Its occurrence may be reduced when the peritonsillar space is infiltrated with local anesthetic.

E. It is usually related to underlying infection.

a. Results in increased oxygen consumption and heat production

b. Makes the use of anticholinergic premedication unwise

c. Plasma catecholamine levels are not elevated

d. Increased cardiac output slows induction

e. Results in increased MAC

a. Minimum alveolar concentration (MAC) is unchanged

b. There may be low voltage in the ECG

c. The stress response may be blunted

d. Atrial fibrillation is a common finding

e. Along with hypothermia, MAC may be decreased

a. Signs and symptoms include darkened pigmentation, hyperkalemia, and hemoconcentration

b. Aldosterone secretion is abnormal in secondary adrenocortical insufficiency

c. Patients manifest increased sensitivity to myocardial depressant drugs

d. Patients may manifest with muscle weakness, weight loss, and hypoglycemia

e. ACTH levels elevated only in primary adrenocortical insufficiency

a. Cardiovascular instability is a common problem in patients chronically on steroids who do not receive a stress dose in the preoperative or early intraoperative period

b. Patients who receive topical steroids need not be considered at risk for adrenal suppression since systemic absorption of steroids is minimal by this route

c. An appropriate recommendation for a patient chronically taking prednisone is for 500mg hydrocortisone to be given IM every 8 hours on the day of surgery for major operations

d. Hydrocortisone is slightly less potent than cortisol

a. The pheochromocytoma is under sympathetic nervous system control

b. Alpha blockade is the first line of treatment

c. Cardiomyopathy is secondary to catecholamine-induced myocardial necrosis

d. Pancuronium is a poor relaxant of choice because it is a sympathetic stimulator

e. Beta blockade may be necessary in patients with dysrhythmia

a. Sympathomimetic drugs should generally be avoided

b. A thyroid storm may mimic malignant hyperthermia

c. Regional anesthesia should be avoided

d. Patients are often sensitive to muscle relaxants, with a prolonged response

e. Beta blockers are part of standard treatment regimens

a. The cardiovascular manifestations are shortened QT interval and pericardial effusion

b. Neuronal irritability may cause seizures and muscle tetany.

c. Trousseau’s sign usually is positive, as well as Chvostek’s sign.

d. Acute hypoparathyroidism May manifest as stridor and/or apnea.

e. Skeletal muscle spasms reflect a reduced threshold of excitation.

a. The normal adult pancreas produces 200-300 U of insulin per day

b. The half life of human insulin is 90 minutes

c. Hepatic dysfunction will increase circulating insulin levels

d. Vagal stimulation will decrease circulating insulin levels

e. Alpha-adrenergic stimulation will increase circulating insulin levels

a. Total body potassium level always will be low

b. The serum potassium level always will be low

c. With appropriate treatment, the serum potassium level will rise acutely

d. All patients with ketoacidosis, except those with acute renal failure, should be given intravenous potassium supplementation

e. With an acidotic patient, the serum potassium concentration may be normal or even slightly elevated.

a. It promotes reabsorption of sodium from the thick ascending limb of the loop of Henle

b. Serum levels decrease with increasing osmolality

c. It functions to relax vascular smooth muscle

d. Has no place in the treatment of von Willebrand disease

e. Target sites may include the collecting tubules of the kidneys