Anesthesiology board review by Kerri M. Robertson, David J Lubarsky, Sudharma Ranasinghe

By Kerri M. Robertson, David J Lubarsky, Sudharma Ranasinghe

Why waste time guessing at what you want to be aware of for anesthesia in-service and board examination? Maximize your examination training time with this quick-hit query and resolution evaluation. the original query and single-answer layout removes the guesswork linked to conventional multiple-choice Q&A reports and reinforces merely the proper solutions you will need to understand on examination day. Emphasis is put on distilling key evidence and medical pearls crucial for examination good fortune. This high-yield overview is ideal for severe, streamlined evaluate within the days and weeks sooner than your examination.

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49 50  ANESTHESIOLOGY BOARD REVIEW How does heparin work? Heparin binds to antithrombin III and increases its affinity for thrombin and the activated forms of X, IX, XI and XIII, effectively neutralizing each.  How does a patient with antithrombin III deficiency usually present? Homozygotes usually die in infancy; 85% of heterozygotes have suffered a thrombotic event by age 50. The diagnosis should be suspected in a patient with thromboembolic disease or a resistance to anticoagulation with heparin administration.

Less than 10% of vascular surgery patients have normal coronary arteries, and more than 50% have advanced or severe CAD.  A patient with COPD is to have a right lung resection for carcinoma. How do you interpret preoperative pulmonary function tests (PFTs)? 85 L or > 70% blood flow to the diseased lung.  Are patients with myasthenia gravis at increased risk for aspiration pneumonitis? Yes. Myasthenics are at increased risk for aspiration pneumonitis, as more than 60% will have a history of bulbar symptoms such as difficulty swallowing and clearing secretions during the course of their disease.

Bupivacaine, lidocaine, etidocaine, mepivacaine, and ropivacaine. Amide local anesthetics contain an “i” in the drug name followed by “caine”. Amides are metabolized in the liver by microsomal enzymes (hydroxylation, Ndealkylation, and hydrolysis).  Which patients are at increased risk for systemic toxicity with lidocaine administration? Those with reduced drug metabolism due to impaired liver function, decreased liver blood flow (ie: cirrhosis or CHF), or markedly reduced plasma proteins (less bound, more free in plasma).

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