ANESTHESIA BOARD PREP EXAM 2025 QUESTIONS AND CORRECT ANSWERS.

ANESTHESIA BOARD PREP EXAM 2025 QUESTIONS AND CORRECT ANSWERS. EKG leads corresponding to RCA territory? The RCA supplies which part of the heart? - CORRECT ANSWERS II, III, aVF RA, the entire RV except for the APEX, posterior/inferior LV, posterior 1/3rd of interventricular septum, SA (50%) & AV (90%) node EKG leads corresponding to LAD territory The LAD supplies which part of the heart? - CORRECT ANSWERS V1, V2, V3, V4 LAD supplies anterior LV, anterior 2/3rds of IV septum, Bundles EKG leads corresponding to Circumflex territory The LCx supplies which part of the heart? - CORRECT ANSWERS I, V5, V6 LCx provides for posterior and lateral LV wall, and anterolateral papillary muscle Nerve supply for Cricothyroid Muscle - CORRECT ANSWERS External Branch of Superior Laryngeal Nerve Nerve supply for everything but Cricothyroid Muscle - CORRECT ANSWERS Recurrent Laryngeal Nerve Postoperative Complications of Thyroid Surgery - CORRECT ANSWERS 1) Airway obstruction due to hematoma Airway obstruction due to bilateral damage to RLN (results in laryngospasm) Hypoparathyroidism (24-96 hours later) - laryngeal stridor leading to laryngospasm Posterior Pituitary produces which hormones - CORRECT ANSWERS Vasopressin and Oxytocin MELD Score - CORRECT ANSWERS INR, Bilirubin, Creatinine, Sodium; Determines who has the highest priority to receive a liver transplant. The higher the number, the more elevated the risk. "CRIB NA" Child Pugh Score - CORRECT ANSWERS INR, Bilirubin, Albumin, Ascites, Encephalopathy; Useful to determine prognosis in patients with cirrhosis. Class A (5-6 points) low risk, Class C (10-15) high risk. Glascow Coma Scale - CORRECT ANSWERS Eye response (4), Verbal (5), Motor (6); Extra value Meal costs $4.56 APGAR - CORRECT ANSWERS Appearance, Pulse, Grimace, Activity, Respiration CVP waveform - CORRECT ANSWERS ACXVY a wave = atrial contraction c wave = ventricular contraction x descent = pulmonic valve opening v wave = venous return of flow y descent = TV opens Innervation of Larynx (sensory) - CORRECT ANSWERS Anterior Tongue -- Vallecula (includes soft palate and oropharynx): CN IX Vallecula/Hypopharynx -- Vocal cords: Internal Branch of SLN Vocal cords -- Trachea -- RLN Innervation of Larynx (motor) - CORRECT ANSWERS Cricothyroid Muscle: External Branch of SLN Everything else: RLN Regional Anesthesia for FOI (3 blocks) - CORRECT ANSWERS 1) Anterior Tonsillar Pillar - Glossopharyngeal Inferior Aspect of Greater Cornu of Hyoid - Internal Branch of SLN Transtracheal - RLN Atracurium metabolite - CORRECT ANSWERS Laudanosine (excreted renally). Can cause seizures and hypotension in patients with renal failure. Side effect: can cause histamine release (transient flushing, hypotension, tachycardia) Metabolism: Eliminated via Hoffman Elimination and Ester Hydrolysis Morphine active metabolite - CORRECT ANSWERS Morphine-6 Glucuronide - accumulates in patients with kidney failure causing respiratory depression Meperidine active metabolite - CORRECT ANSWERS Normeperidine (excreted renally) - accumulates in patients with renal failure causing seizures Hydromorphone active metabolite - CORRECT ANSWERS Hydromorphone 3 Glucuronide (excreted renally) - accumulates in patients with renal failure causing cognitive dysfunction and myoclonus Magnesium Effect on NMBDs - CORRECT ANSWERS Mg prolongs neuromuscular blocking agents Free Water Deficit equation - CORRECT ANSWERS (0.6 x Kg) x (Serum Na - Desired Na / Desired Na) Diabetes Insipidus vs Cerebral Salt Wasting vs SIADH - CORRECT ANSWERS Plavix Mechanism of Action - CORRECT ANSWERS Blocks ADP receptor (Activation of ADP leads to surface expression of IIb/IIIa receptor on platelets - where fibrinogen and vWF binds). It is non competitive and irreversible. Warfarin Mechanism of Action - CORRECT ANSWERS Blocks Vit K epoxide reductase. Leads to depletion of clotting factors II, VII, IX, X, protein C and protein S. Factor VII will be depleted first Argatroban Mechanism of Action - CORRECT ANSWERS Direct Thrombin Inhibitor. Hepatic clearance. t1/2: 40-50mins Bivalrudin Mechanism of Action - CORRECT ANSWERS Direct Thrombin Inhibitor. Cleared by plasma proteases. t1/2: 25mins Hirudin Mechanism of Action - CORRECT ANSWERS Direct Thrombin Inhibitor. Renal elimination. t1/2: 80min Fondaparinux Mechanism of Action - CORRECT ANSWERS Factor Xa inhibitor. Renal elimination. Dabigatran mechanism of action? - CORRECT ANSWERS Direct thrombin inhibitor; renally cleared Rivaroxiban (xarelto) mechanism of action? - CORRECT ANSWERS Direct Xa inhibitor, use with caution in hepatic and renal insufficiency DDAVP - CORRECT ANSWERS Antagonizes V2 receptor. Regulates water reabsorption and can cause a release of vWF. Indicated in DI and vWD and mild hemophilia A. TXA and Aminocaproic Acid Mechanism of Action - CORRECT ANSWERS Binds to plasminogen and blocks the activation of plasmin (pro-thrombotic) HIT Type I vs Type II - CORRECT ANSWERS Type 1: Non immune mediated. Seen after 1st day of exposure. Transient and insignificant Type 2: Immune mediated. IgG binds to PF4, activates platelets and causes aggregation. Seen 5-10 days after exposure. Management: switch to direct thrombin inhibitors (bivalrudin, argatroban, fondaparinux vWD Type 1 vs Type 2 vs Type 3 - CORRECT ANSWERS Type 1: Quantitative decrease in vWF. AD. Tx: Desmopressin Type 2: Qualitative abnormality in vWF. AD Type 3: Rare, undetectable levels of vWF. Body does not produce it. Lambert Eaton Syndrome sensitive/resistant to Succinylcholine/NMBDs? - CORRECT ANSWERS Sensitive to both Succinylcholine and NMBDs. Myasthenia Gravis sensitive/resistant to Succinylcholine/NMBDs? - CORRECT ANSWERS Resistant to Succinylcholine but sensitive to NMBDs. How to tell the difference between Myasthenic Crisis vs Cholinergic Crisis? - CORRECT ANSWERS Give Edrophonium -- Increased weakness points to cholinergic crisis; Improvement or Decreased weakness points to Myasthenic crisis Tx of Myasthenia Gravis - CORRECT ANSWERS Anticholinesterase inhibitors - Pyridostigmine Malignant Hyperthermia Diagnosis - CORRECT ANSWERS Gold standard - Halothane- caffeine Test Treacher Collins Syndrome - CORRECT ANSWERS Difficult airways, autosomal dominant, genetic mutation, 1:50,000 live births Mandibular/Maxillary Hypoplasia (micrognathia, absent cheekbones) Cleft or Arched Palate Macrostomia Fish like facies Choanal Atresia Cor Pulmonale OSA Conductive hearing loss, malformed ears Pierre Robin Syndrome - CORRECT ANSWERS Triad (Disappears after 2 years of age): Hypoplastic Mandible Glossoptosis - posterior displacement of the base of the tongue over epiglottis Cleft palate Usually with respiratory distress after 24 hours Associated with Cor pulmonale, OSA 1cm elevation = what change of mmHg? - CORRECT ANSWERS 0.74mmHg; Example 10cm elevation = reading will be 7.5mmHg higher than baseline Types of Heat Loss? #1 cause of intraop heat loss? - CORRECT ANSWERS Convection, Conduction, Evaporation, Radiation. Radiation is the #1 cause of heat loss intraoperatively Anterior/Posterior Ischemic Optic Neuropathy Associations - CORRECT ANSWERS Associated with: Prone surgeries Spine cases Cardiopulmonary Bypass cases Males Hypotension Anemia, 6hr Surgery, Increased Venous/Eyeball pressure Less Colloids Vessel Rich Organs vs Vessel Poor Organs - CORRECT ANSWERS Rich = Brain, Kidney, Heart, Liver, Adrenals (does NOT include lungs because normally the lungs receive 100% of CO) Med = Muscle, Skin Poor = Bone, Cartilage, Ligaments Meperidine Facts - CORRECT ANSWERS - Causes Histamine Release Metabolite Normeperidine - accumulates in renal patients potentially causing seizures MAO inhibitor + Meperidine can lead to serotonin syndrome (confusion, hyperthermia, shivering, myoclonus, and hyperreflexia) K agonism to oppose shivering Meperidine is a strong anticholinergic Potency 0.1 compared to Morphine Baclofen binds to which receptor - CORRECT ANSWERS GABA-B. Benzodiazepines bind to GABA-A. Opioid Receptors - CORRECT ANSWERS Mu1: analgesia, skeletal muscle rigidity Mu2: respiratory depression Kappa: sedation, dysphoria, miosis. Antagonizes shivering