Thursday, February 12, 2015

ACE 2009 6B x x

1. In Adult with mediastinal mass, the greatest risk of adverse event by CT scan is pericardial effusion, not airway compression...

3. Cerebral palsy does not increase dosing of succinylcholine as it does not result in extrajunctional receptors. More nondepolarizing NMBs are required for same effect though.

5. People who are sensitive to latex: people who work in OR, people who need catheterization (spinal cord issues)

10. C5 innervates no fingers. C6 - thumb and index, C7 - index and middle, C8 - ring and pinky

11. Parturient's hearts grow, leading to increased diameter of all 4 chambers and mitral valve. This leads to lower threshold for dysrhythmias.

16. Desflurane creating CO more than other volatiles. Desiccated gas on monday morning.


18. MV changes by 3L/min per 1mmHg of increase or decrease of PaCO2. This is mediated by central chemoreceptors.
19. Succinylcholine does increase intraocular pressure but may be necessary for case so not absolute contraindication.
26.  Mapleson systems spontaneous ventilation can be summarized as follows: A > DFE > CB.  During controlled ventilation, DFE > BC > A
31. What increases A-a gradient. Remember that hypoxemia is due to 5 causes and A-a gradient changes in the first 3:

Shunt, VP mismatch, Poor diffusion, Altitude, Hypoventilation (hypercarbia does not change A-a gradient)

32. Multiple sclerosis avoid succinylcholine 2/2 hyperkalemia. Sensitivity to NMB. Regional vs general both can cause exacerbation though epidural is thought to be safer than spinal.



46. Noxious s timulus with cause 2 distinct sensations carried by A-delta fibers and C fibers. First is well localized, sharp and brief. 2nd is dull, not well localized. Speed of conduction is 10-20m/s for a-delta while C is 1/m/s

49. Most common symptom of uterine rupture is fetal bradycardia. Rate of rupture in low transverse c/s is 0.8-1.6 percent.


55. Babies respond to cold by vasoconstriction of skin and non-shivering thermogenesis. There is a chance that a premature neonate returns to fetal circulatory pattern 2/2 cold because there is an increase in PAP causing opening of the PFO and also increasing O2 usage may result in ypoxemia -> opening ductus arteriosus.

64. Peripartum cardiomyopathy is defined by development of EF <45% in the last month of pregnancy or 5 months after delivery without identifiable cause. Pt must not have HF for another reason before the last month.

 72. Aspirin or salicylate poisoning causes a metabolic acidosis but also a respiratory alkalosis from hyperventilation 2/2 stimulating respiratory center. Give sodium bicarbonate to alkalinze urine.

73. Three-legged stool: parenchymal (DLCO <40%, PaO2 <65, PaCO2>45), functional (Vmax >15), spirometry (FEV < 2L, VC < 50%, RV/TLC > 50%)

74. If initial screening for postoperative risk s/p pneumonectomy is bad, followup testing is warranted. Split lung function testing utilizes VQ scans with radioisotopes. Predicted postoperative FEV1 <0.85L, blood flow >70% to diseased lung. Third phase of testing if split lung function is concerning is balloon occlusion to main bronchus of operative lung. Measure PAP>45, PaCO2 >60, PaO2 <45, severe dyspnea.







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