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MOCA
Airway
Herbal
Anesthesia Gases
Non Depolarizing Neuromuscular Blocking Agents
100
Of the following airway characteristics, this one MOST likely reliably predicts dificulty visualizing the larynx during direct laryngoscopy A. Thyromental distance of 4 fingerbreadths B. Neck circumference of 30cm C. BMI of 25 kg/m2 D. Inter-incisor distance of 2 cm
What is D?
100
These two reflexes should be depressed before an oral airway is inserted to avoid coughing or laryngospasm
What are the pharyngeal and laryngeal reflexes?
100
Concerning FDA regulation of herbal medications, this is the percentage of the market that is tested. (1%, 5%, 10%, 20%)
What is 1%? Only 1% of the herbal medicines on the market are spot tested of the 65,000 dietary supplements available due to limitations of resources.
100
This is the MAC of desflurane
What is 6.7?
100
This steroidal NMB is long acting and is 40% renally cleared.
What is pancuronium?
200
A 77y/o woman w/ CAD had a bare metal stent placed and is taking ASA and clopidogrel. Her surgeon would like to schedule a ligation and stripping of painful lower extremity varicosities so she can resume her active lifestyle. After stent placement, this is the earliest time point MOST appropriate to discontinue clopidogrel for elective surgery
What is one month? In patients w/ coronary stents undergoing elective surgical procedures the type of stent determines the optimal timing of elective surgery.
200
Absence of a motor response to this maneuver is a reliable method for assessing the adequacy of anesthesia LMA insertion
What is the jaw thrust maneuver?
200
This is the amount of time the ASA recommends herbal medicines be discontinued before surgery. (1 week, 2 weeks, 24hours, not discontinued)
What is 2 weeks?
200
Vapor pressure of isoflurane
What is 240?
200
Hypothermia, acidodis, hypokalemia, and hypocalcemia does this to the duration of action of non depolarizing NMB.
What is prolong the duration of action?
300
After a laryngospasm, a 22yo in PACU develops pink frothy sputum and has an SpO2 of 85% on supplemental O2 (FiO2 .5). This intervention is the most appropriate to treat his hypoxemia.
What is noninvasive ventilation? (CPAP) Negative pressure pulmonary edema usually only requires supportive therapy with supplemental oxygen and CPAP.
300
Cervical spine movement w/ this blade is greater compared to a Miller, lightwand, and glidescope
What is the MAC blade?
300
This herbal supplement has MAOI effects. (St. Johns Wort, ginseng, echinacea, garlic)
What is St. Johns Wort?
300
The phenomenon when a large volume of 1 gas accelerates uptake of a companion gas
What is second gas effect?
300
This NMB has an onset of about 2 minutes and has fewer active metabolites than vecuronium.
What is rocuronium? (90sec onset w/ 1.2mg/kg)
400
After an uneventful GA w/ isoflurane, fentanyl, and sux, a 20yo man develops diffuse muscle rigidity, tachycardia, fever of 40degC and metabolic acidemia. MH is suspected as the cause. 2.5mg/kg of dantrolene is administered every 5 min. This is the therapeutic endpoint that is the most appropriate indication to stop dantrolene administration.
What is resolution of signs that indicate hypermetabolism? Dantrolene should be administered during episodes of MH until major cardiorespiratory effects of hypermetabolism have resolved.
400
The cuff on an ETT should seal w/o exerting so much pressure on the trach that circulation is compromised or the trach becomes dilated. Current guidelines suggest that pressure measured on THIS structure at the end expiration should be between 25-34cm H2O.
What is the lateral tracheal wall?
400
This is a perioperative complication associated with kava. (bleeding, HTN, seizures, broncospasm)
What is bleeding? It reduces platelet aggregation through inhibition of cyclyooxygenase and thromboxane.
400
This is the only inhaled agent which does not alter PaCO2
What is nitrous oxide?
400
Cisatracurium is metabolized by these methods.
What is Hoffman elimination and ester hydrolysis?
500
A physically active, 57yo man w/ CAD would like to have a mastopexy. He has been on ASA and clopidogrel since placement of a drug eluting stent 3 months ago. This is the point after stent placement that is MOST appropriate to consider discontinuing clopidogrel for elective surgery.
What is twelve months? In patients w/ coronary stents undergoing elective surgical procedures the type of stent determines the optimal timing of elective surgery.
500
The RAE tube was named after these three inventors
Who are Ring, Adair, and Elwyn?
500
Delayed emergence from GA may be seen with this herbal drug. (Valerian, ginseng, ginko, ephedra)
What is valerian? Due to modulation of GABA receptors.
500
Unlike other halogenated agents, this one cant cause "halothane hepatitis" because triflouracetate is one of its metabolites
What is sevoflurane?
500
This benzoisoquinoline NMB is no longer available but was metabolized by pseudocholinesterase.
What is mivacurium?