Clinical Cases in Anesthesia
- Lecture Notes, Study Materials and Important questions answers

Subject : Clinical Cases in Anesthesia

Cardiopulmonary Resuscitation

1. Cardiopulmonary Resuscitation - Answer (click here)
2. What is the initial response to a cardiac arrest? - Answer (click here)
3. How do chest compressions produce a cardiac output? - Answer (click here)
4. What are the recommended rates of compression and ventilation? - Answer (click here)
5. What are the complications of CPR? - Answer (click here)
6. What is the optimal dose of epinephrine? - Answer (click here)
7. What is the indication for vasopressin in CPR? - Answer (click here)
8. What are the indications for sodium bicarbonate (NaHCO3) administration? - Answer (click here)
9. What are the indications for calcium salt administration? - Answer (click here)
10. What is the antidysrhythmic therapy of choice in VF/pulseless VT? - Answer (click here)
11. What are the management strategies in bradycardias? - Answer (click here)
12. What is the treatment of supraventricular tachydys-rhythmias? - Answer (click here)
13. What are the indications for magnesium therapy? - Answer (click here)
14. What are the indications for a pacemaker? - Answer (click here)
15. Why is it important to monitor serum glucose? - Answer (click here)
16. What are the indications for open cardiac massage? - Answer (click here)
17. What is the management strategy for pulseless electrical activity (PEA)? - Answer (click here)

Coronary Artery Disease

1. Coronary Artery Disease - Answer (click here)
2. What are the determinants of myocardial oxygen supply? - Answer (click here)
3. What are the determinants of myocardial oxygen consumption (demand)? - Answer (click here)
4. What are the pharmacologic alternatives for treating myocardial ischemia in this patient? - Answer (click here)
5. What is coronary steal and what agents might induce it? - Answer (click here)
6. Should this patient receive perioperative β-adrenergic blockade? - Answer (click here)
7. How should this patient be monitored intraoperatively? - Answer (click here)

Recent Myocardial Infarction

1. Recent Myocardial Infarction - Answer (click here)
2. How do you evaluate the cardiac risk in a patient scheduled for noncardiac surgery? - Answer (click here)
3. What is the cardiac risk in this patient? What additional investigations should be performed? - Answer (click here)
4. What are the implications for anesthetic management when coronary revascularization is performed before noncardiac surgery? - Answer (click here)
5. What intraoperative monitors would you use? - Answer (click here)
6. What additional drugs would you have prepared? - Answer (click here)
7. What anesthetic technique would you use? - Answer (click here)
8. How would you manage this patient postoperatively? - Answer (click here)

Congestive Heart Failure

1. Congestive Heart Failure - Answer (click here)
2. What are possible etiologies for dilated cardio-myopathy? - Answer (click here)
3. What is the pathophysiology of dilated cardiomyopathy? - Answer (click here)
4. How would you monitor this patient during the perioperative period? - Answer (click here)
5. How would you anesthetize this patient? - Answer (click here)

Aortic Stenosis

1. Aortic Stenosis - Answer (click here)
2. What are the symptoms and long-term prognosis of aortic stenosis? - Answer (click here)
3. What is the etiology of aortic stenosis? - Answer (click here)
4. How is the aortic valve area calculated? - Answer (click here)
5. Why is it important to maintain sinus rhythm? - Answer (click here)
6. What is the treatment for supraventricular tachy-dysrhythmias or bradydysrhythmias? - Answer (click here)
7. How is hypotension best treated in the patient with aortic stenosis? - Answer (click here)
8. How would you anesthetize this patient for cardiac or noncardiac surgery? - Answer (click here)

Mitral Stenosis

1. Mitral Stenosis - Answer (click here)
2. What is the etiology and pathophysiology of mitral stenosis? - Answer (click here)
3. How should preload, afterload, heart rate, and contractility be managed in a patient with mitral stenosis? - Answer (click here)
4. How would you optimize this patient’s condition preoperatively? - Answer (click here)
5. What intraoperative monitoring would be appropriate? - Answer (click here)
6. How would you anesthetize this patient? - Answer (click here)
7. How should hypotension be treated in a patient with mitral stenosis? - Answer (click here)
8. What is the treatment for perioperative right ventricular failure? - Answer (click here)

Eisenmenger Syndrome Subacute Bacterial Endocarditis Prophylaxis

1. Eisenmenger Syndrome (Subacute Bacterial Endocarditis Prophylaxis) - Answer (click here)
2. What are the anesthetic considerations for a patient with Eisenmenger syndrome? - Answer (click here)
3. What is the association between bacterial endocarditis and structural heart disease? - Answer (click here)
4. Which patients should receive endocarditis prophylaxis? - Answer (click here)
5. What are the most likely pathogens involved in subacute bacterial endocarditis and what are the antibiotics of choice for its treatment? - Answer (click here)

Hypertrophic Obstructive Cardiomyopathy

1. Hypertrophic Obstructive Cardiomyopathy - Answer (click here)
2. Describe the anatomic abnormalities in HOCM - Answer (click here)
3. What changes in preload, afterload, heart rate, and contractility will optimize hemodynamic performance in a patient with HOCM? - Answer (click here)
4. What are the treatment options for HOCM? - Answer (click here)
5. What monitoring would be required in HOCM patients? - Answer (click here)
6. What considerations should be given in planning the anesthetic management of a patient with HOCM? - Answer (click here)
7. What are the special considerations for anesthetic management of labor and delivery in a patient with HOCM? - Answer (click here)

Cardiac Pacemakers and Defibrillators

1. Cardiac Pacemakers and Defibrillators - Answer (click here)
2. What do the first three letters of the pacemaker code represent? - Answer (click here)
3. What is the difference between a demand and an asynchronous pacemaker? - Answer (click here)
4. What is the difference between ventricular (single-chamber) and dual-chamber pacemakers? - Answer (click here)
5. Is a unipolar or bipolar pacemaker more sensitive to electrocautery interference? - Answer (click here)
6. How is pacemaker interference by electrocautery prevented? - Answer (click here)
7. What is pacemaker hysteresis? - Answer (click here)
8. What causes myopotential inhibition of a pacemaker? - Answer (click here)
9. What is an automatic implantable cardioverterdefibrillator (AICD)? - Answer (click here)
10. How is the patient with an AICD managed in the perioperative period? - Answer (click here)

Cardiac Tamponade

1. Cardiac Tamponade - Answer (click here)
2. What is the pathophysiology of cardiac tamponade? - Answer (click here)
3. What are the clinical signs and symptoms of cardiac tamponade? - Answer (click here)
4. What is the initial management of this patient’s condition? - Answer (click here)
5. What intraoperative monitoring techniques should be used? - Answer (click here)
6. Describe the implications for the conduct of general anesthesia in this patient - Answer (click here)

Cardiomyopathy Managed With A Left Ventricular Assist Device

1. Cardiomyopathy Managed With A Left Ventricular Assist Device - Answer (click here)
2. What is a cardiomyopathy? - Answer (click here)
3. Distinguish dilated cardiomyopathy from other cardiomyopathies - Answer (click here)
4. Explain the treatment options for dilated cardiomyopathies - Answer (click here)
5. What is an LVAD? - Answer (click here)
6. What are the important anesthetic considerations for patients supported by LVADs? - Answer (click here)
7. What intra-anesthetic monitoring might be required for patients with LVADs? - Answer (click here)

Noncardiac Surgery After Heart Transplantation

1. Noncardiac Surgery After Heart Transplantation - Answer (click here)
2. Describe the physiology of transplanted hearts - Answer (click here)
3. Is reinnervation of the transplanted heart a concern? - Answer (click here)
4. Which immunosuppressive medications are typically used following cardiac transplantation? - Answer (click here)
5. Explain the pre-anesthetic concerns for patients with a transplanted heart - Answer (click here)
6. What anesthetic techniques are applicable to patients with cardiac transplants? - Answer (click here)
7. What intraoperative monitors should be used in the patient with a transplanted heart? - Answer (click here)
8. What emergency drugs are likely to be effective in the patient with a transplanted heart? - Answer (click here)
9. For patients with a transplanted heart, is it necessary to administer anticholinergics when antagonizing neuromuscular blockade? - Answer (click here)

Coronary Artery Bypass Grafting

1. Coronary Artery Bypass Grafting - Answer (click here)
2. What are the major determinants of myocardial oxygen supply and demand? - Answer (click here)
3. What types of medications are used to treat coronary artery disease? - Answer (click here)
4. What are the pre-anesthetic concerns in the patient with coronary artery disease? - Answer (click here)
5. What intraoperative monitoring techniques can be used for the patient undergoing cardiac surgery using cardiopulmonary bypass (CPB)? -Answer (click here)
6. What are the common intraoperative monitors for myocardial ischemia? - Answer (click here)
7. What are the effects of CPB on the lungs, the brain, and the kidneys? - Answer (click here)
8. What are the effects of CPB on hemostasis? - Answer (click here)

Do Not Resuscitate Order

1. Do-Not-Resuscitate Order - Answer (click here)
2. What is meant by temporary revocation of do-not-resuscitate (DNR) orders in the operating room? - Answer (click here)
3. What did you discuss with the patient prior to surgery regarding resuscitation efforts in the operating room? - Answer (click here)
4. What options are available to the patient and clinician in order to more fully define a patient’s DNR wishes? - Answer (click here)
5. What would you do in this case, if the patient could not be adequately ventilated with a mask? - Answer (click here)
6. If this patient were intubated for the resuscitation but did not regain consciousness for 48 hours, is it ethical to withdraw mechanical ventilation at this time? - Answer (click here)

One Lung Anesthesia

1. One-Lung Anesthesia - Answer (click here)
2. Describe the anesthetic evaluation before lung resection - Answer (click here)
3. How are ventilation and oxygenation monitored noninvasively during surgery, and how do these monitors work? - Answer (click here)
4. What are the indications for one-lung ventilation? - Answer (click here)
5. Describe the use of single-lumen endotracheal tubes for one-lung ventilation - Answer (click here)
6. Which sided double-lumen endobronchial tube should be used for this patient? - Answer (click here)
7. Describe the proper technique for placing a double-lumen endobronchial tube - Answer (click here)
8. How is correct positioning of the double-lumen endobronchial tube assessed? - Answer (click here)
9. What clinical problems are associated with the place-ment and use of double-lumen endobronchial tubes? - Answer (click here)
10. What complications are related to placing the patient in the lateral decubitus position? - Answer (click here)
11. How are pulmonary perfusion and ventilation altered during one-lung ventilation? - Answer (click here)
12. What is the treatment for hypoxemia during one-lung anesthesia? - Answer (click here)
13. Describe the role of a thoracostomy tube following pulmonary resection, and describe the system used for pleural drainage - Answer (click here)
14. Describe a commonly used pleural drainage system - Answer (click here)
15. Discuss potential post-thoracotomy complications - Answer (click here)

Thoracoscopy

1. Thoracoscopy - Answer (click here)
2. What types of operations can be done with VAT? - Answer (click here)
3. What are the advantages of performing the surgery utilizing VAT in comparison with traditional thoracotomy? - Answer (click here)
4. What anesthetic techniques can be utilized for VAT? - Answer (click here)
5. How can hypoxemia due to shunting during one-lung ventilation be treated? - Answer (click here)
6. What complications can occur with VAT? - Answer (click here)

Intracranial Mass Intracranial Pressure Venous Air Embolism And Autoregulation

1. Intracranial Mass, Intracranial Pressure, Venous Air Embolism, And Autoregulation - Answer (click here)
2. What is cerebral autoregulation? - Answer (click here)
3. What factors contribute to increased intracranial pressure (ICP)? - Answer (click here)
4. How do anesthetic agents and vasoactive drugs affect cerebral blood flow (CBF) and ICP? - Answer (click here)
5. What are the signs and symptoms of increased ICP? - Answer (click here)
6. How is ICP monitored? - Answer (click here)
7. How is increased ICP treated? - Answer (click here)
8. How is venous air embolism (VAE) detected and treated? - Answer (click here)
9. What are the contraindications to the sitting position? - Answer (click here)
10. How would you induce and maintain anesthesia in this patient? - Answer (click here)

Intracranial Aneurysms

1. Intracranial Aneurysms - Answer (click here)
2. How are patients graded following subarachnoid hemorrhage from a ruptured aneurysm? - Answer (click here)
3. What are the most serious complications following subarachnoid hemorrhage from aneurysm rupture? - Answer (click here)
4. What are the treatment options? - Answer (click here)
5. What monitoring is indicated for patients undergoing craniotomy for clipping of intracranial aneurysm? - Answer (click here)
6. How is arterial blood pressure controlled? - Answer (click here)
7. What is cerebral vasospasm, and how is it treated? - Answer (click here)
8. How is aneurysm rupture during aneurysm clipping managed? - Answer (click here)

Carotid Endarterectomy

1. Carotid Endarterectomy - Answer (click here)
2. What are the indications for surgical carotid endarterectomy (CEA)? - Answer (click here)
3. What are the alternatives to surgical CEA? - Answer (click here)
4. What are the most serious perioperative complications? - Answer (click here)
5. How is the patient’s neurologic status monitored? - Answer (click here)
6. What interventions may reduce the risk of neurologic injury? - Answer (click here)

Electroconvulsive Therapy

1. Electroconvulsive Therapy - Answer (click here)
2. What are the physiologic effects of ECT? - Answer (click here)
3. What are the anesthetic agents of choice for ECT? - Answer (click here)
4. Describe the preanesthetic evaluation of ECT patients - Answer (click here)
5. What are the anesthetic implications of psychotropic agents used in patients receiving ECT? - Answer (click here)
6. How would you anesthetize this particular patient for ECT? - Answer (click here)
7. What are the contraindications to ECT? - Answer (click here)

Spine Surgery

1. Spine Surgery - Answer (click here)
2. What are the considerations for surgery in the prone position? - Answer (click here)
3. What monitors will you use for this case? - Answer (click here)
4. What are somatosensory and motor evoked potentials? - Answer (click here)
5. Describe the effects of anesthetics on somatosensory and motor evoked potentials - Answer (click here)
6. What is a “wake-up” test? - Answer (click here)
7. What is the bispectral index state (BIS)? Is monitoring the BIS useful in this case? - Answer (click here)
8. Is this patient at risk for postoperative vision loss? - Answer (click here)
9. What modalities exist for pain relief after spine surgery? - Answer (click here)

Transsphenoidal Hypophysectomy

1. Transsphenoidal Hypophysectomy - Answer (click here)
2. What is acromegaly? - Answer (click here)
3. What symptoms are typical of the disease? - Answer (click here)
4. How is the disease treated? - Answer (click here)
5. What are the anesthetic considerations of acromegaly? - Answer (click here)
6. How would you approach the airway management in this patient? - Answer (click here)
7. What structures lie within the transsphenoidal surgical field? - Answer (click here)
8. What is diabetes insipidus? - Answer (click here)
9. What are the postoperative concerns for this patient? - Answer (click here)

Depolarizing Neuromuscular Blockade

1. Depolarizing Neuromuscular Blockade - Answer (click here)
2. Describe the anatomy and physiology of normal neuromuscular transmission - Answer (click here)
3. How does succinylcholine produce muscle relaxation? - Answer (click here)
4. What are extrajunctional receptors? - Answer (click here)
5. How is the action of succinylcholine terminated? - Answer (click here)
6. What factors may decrease the normal metabolism of succinylcholine? - Answer (click here)
7. Describe a phase II block - Answer (click here)
8. What is the treatment of phase II blockade? - Answer (click here)
9. Describe other recognized side-effects of succinyl-choline - Answer (click here)
10. What are the contraindications to succinylcholine administration? - Answer (click here)

NonDepolarizing NeuroMuscular Blockade

1. NonDepolarizing NeuroMuscular Blockade - Answer (click here)
2. Describe the mechanism by which nondepolarizing neuromuscular blockers produce neuromuscular blockade - Answer (click here)
3. Differentiate between the commonly employed non-depolarizing muscle relaxants - Answer (click here)
4. Briefly outline the mechanisms by which drugs other than neuromuscular muscle relaxants affect neuro-muscular blockade - Answer (click here)
5. What effects do antibiotics have on neuromuscular blockade? - Answer (click here)
6. How do drugs other than antibiotics affect neuro-muscular blockade? - Answer (click here)
7. What are the metabolic factors that affect antagonism of neuromuscular blockade? - Answer (click here)

Antagonism of Nondepolarizing Neuromuscular Blockade

1. Antagonism of Nondepolarizing Neuromuscular Blockade - Answer (click here)
2. Describe the overall strategy for terminating the action of nondepolarizing neuromuscular blockade - Answer (click here)
3. List the clinically relevant acetylcholinesterase inhibitors - Answer (click here)
4. What is the mechanism of acetylcholinesterase inhibition? - Answer (click here)
5. List the proper doses of muscle relaxant antagonists and their duration of action - Answer (click here)
6. Explain the need for antimuscarinics used in conjunction with acetylcholinesterase inhibitors - Answer (click here)
7. What is the onset of action for acetylcholinesterase inhibitors? - Answer (click here)
8. Describe the mechanism of muscle relaxant antagonism by cyclodextrins - Answer (click here)
9. Explain the clinical indices of recovery from neuro-muscular blockade - Answer (click here)

Monitoring the Neuromuscular Junction

1. Monitoring the Neuromuscular Junction - Answer (click here)
2. Why is monitoring of neuromuscular function necessary in the practice of anesthesia? - Answer (click here)
3. What is the mechanomyograph (MMG)? - Answer (click here)
4. Describe the electromyograph (EMG) - Answer (click here)
5. What kind of nerve stimulator is in common clinical use? - Answer (click here)
6. Describe accelerography - Answer (click here)
7. What is phonomyography? - Answer (click here)
8. Explain the different patterns of nerve stimulation and the relevance of pattern choice - Answer (click here)

Myasthenia Gravis

1. Myasthenia Gravis - Answer (click here)
2. What is the lesion of myasthenia gravis (MG)? - Answer (click here)
3. How is MG diagnosed? - Answer (click here)
4. Explain the treatment alternatives for MG - Answer (click here)
5. Why are patients with MG sensitive to nondepolariz-ing muscle relaxants and resistant to depolarizing muscle relaxants? - Answer (click here)
6. How are patients with MG premedicated for surgery? - Answer (click here)
7. Describe a reasonable anesthetic technique for a patient with MG undergoing transcervical thymectomy - Answer (click here)
8. Following emergence from anesthesia and before extubation, how is strength assessed? - Answer (click here)
9. What is cholinergic crisis? - Answer (click here)
10. Can preoperative evaluation predict the need for postoperative ventilation? - Answer (click here)

Malignant Hyperthermia

1. Malignant Hyperthermia - Answer (click here)
2. What is malignant hyperthermia (MH)? - Answer (click here)
3. How is susceptibility to MH inherited? - Answer (click here)
4. What is the pathophysiology of MH? - Answer (click here)
5. What characterizes a clinical episode of MH? - Answer (click here)
6. Outline the pharmacology of dantrolene - Answer (click here)
7. How is MH treated? - Answer (click here)
8. How are patients with known MH susceptibility treated? - Answer (click here)
9. What are the recognized triggering agents? - Answer (click here)
10. What is the significance of masseter muscle rigidity (MMR)? - Answer (click here)
11. How is MH definitively diagnosed? - Answer (click here)
12. Describe the neurolept malignant syndrome - Answer (click here)

Diabetes Mellitus

1. Diabetes Mellitus - Answer (click here)
2. Distinguish among the major types of diabetes mellitus (DM) - Answer (click here)
3. Summarize the physiologic effects of insulin - Answer (click here)
4. Describe the oral hypoglycemic agents and insulin preparations available to treat DM - Answer (click here)
5. How does DM affect perioperative morbidity and mortality? - Answer (click here)
6. What are the common causes and associated symptoms of hypoglycemia? - Answer (click here)
7. Outline perioperative management alternatives for the diabetic patient - Answer (click here)
8. Explain the acute complications of DM - Answer (click here)
9. Thyroid Disease - Answer (click here)
10. How does the thyroid affect vital organ function? - Answer (click here)
11. How is thyroid hormone synthesized and released? - Answer (click here)
12. How is thyroid hormone regulated? - Answer (click here)
13. How are thyroid disorders evaluated? - Answer (click here)
14. What other conditions are associated with thyroid disorders? - Answer (click here)
15. What is thyroid storm and how is it treated? - Answer (click here)
16. What are the causes of hyperthyroidism? - Answer (click here)
17. What are the causes of hypothyroidism? - Answer (click here)
18. What are the preoperative considerations in a patient with thyroid disease? - Answer (click here)
19. What are appropriate preoperative tests for a patient with thyroid disease? - Answer (click here)
20. What are the intraoperative concerns with coexisting thyroid disease? - Answer (click here)
21. What are the postoperative concerns? - Answer (click here)

Thyroid Disease

1. Thyroid Disease - Answer (click here)
2. How does the thyroid affect vital organ function? - Answer (click here)
3. How is thyroid hormone synthesized and released? - Answer (click here)
4. How is thyroid hormone regulated? - Answer (click here)
5. How are thyroid disorders evaluated? - Answer (click here)
6. What other conditions are associated with thyroid disorders? - Answer (click here)
7. What is thyroid storm and how is it treated? - Answer (click here)
8. What are the causes of hyperthyroidism? - Answer (click here)
9. What are the causes of hypothyroidism? - Answer (click here)
10. What are the preoperative considerations in a patient with thyroid disease? - Answer (click here)
11. What are appropriate preoperative tests for a patient with thyroid disease? - Answer (click here)
12. What are the intraoperative concerns with coexisting thyroid disease? - Answer (click here)
13. What are the postoperative concerns? - Answer (click here)

Calcium Metabolism

1. Calcium Metabolism - Answer (click here)
2. What is the role of calcium in the body? - Answer (click here)
3. Where is calcium found in the body? - Answer (click here)
4. How is calcium regulated? - Answer (click here)
5. What are the symptoms of hypercalcemia? How is this treated? - Answer (click here)
6. What are the symptoms of hypocalcemia? How is this treated? - Answer (click here)
7. What are the causes of hyperparathyroidism? - Answer (click here)
8. What are the anesthetic considerations for parathyroid resection? - Answer (click here)
9. What are the postoperative concerns after parathyroid resection? - Answer (click here)

Perioperative Corticosteroid Administration

1. Perioperative Corticosteroid Administration - Answer (click here)
2. Where and what kind of steroids are naturally produced? - Answer (click here)
3. What are the physiologic effects of glucocorticosteroids? - Answer (click here)
4. What steroids are available for administration and what are their equivalent doses? - Answer (click here)
5. How much cortisol is normally produced and what is Addison’s disease? - Answer (click here)
6. What are Cushing syndrome and Cushing disease? - Answer (click here)
7. Does this patient require “stress” dose steroids? - Answer (click here)
8. How long after discontinuation of steroids should a patient be considered adrenally suppressed and treated accordingly? - Answer (click here)
9. What clinical scenarios frequently require steroid administration? - Answer (click here)
10. How is adrenal reserve evaluated? - Answer (click here)
11. If this patient develops septic shock from a bile leak in the postanesthesia care unit (PACU), should steroids be withheld or administered? -Answer (click here)

Pheochromocytoma

1. Pheochromocytoma - Answer (click here)
2. What is a pheochromocytoma? - Answer (click here)
3. Describe the clinical presentation of and diagnostic criteria for pheochromocytoma - Answer (click here)
4. Pheochromocytoma is associated with what other syndromes? - Answer (click here)
5. What conditions may mimic pheochromocytoma? - Answer (click here)
6. How are patients with pheochromocytoma prepared for surgery? - Answer (click here)
7. Describe the intraoperative management goals - Answer (click here)
8. Outline the anesthetic choices for pheochromocytoma - Answer (click here)
9. What are the special postoperative problems associated with resection of a pheochromocytoma? - Answer (click here)
10. How is a previously unsuspected and undiagnosed pheochromocytoma managed following induction of anesthesia? - Answer (click here)

Full Stomach

1. Full Stomach - Answer (click here)
2. What are the mechanisms a conscious patient has to prevent regurgitation and pulmonary aspiration? - Answer (click here)
3. What are the risk factors for regurgitation and pulmonary aspiration under general anesthesia? - Answer (click here)
4. When can aspiration occur during the perioperative period? - Answer (click here)
5. What are the problems associated with aspiration? - Answer (click here)
6. If aspiration occurs, what are the usual course, treat-ment and prognosis? - Answer (click here)
7. How should the nasogastric tube (NGT) be managed during induction? - Answer (click here)
8. What pharmacologic interventions can be made to decrease the risk of aspiration? - Answer (click here)
9. What is the reason for applying cricoid pressure during a rapid sequence induction, and what are some of the problems associated with it? -Answer (click here)
10. What is the effect of commonly used pharmacological agents during anesthesia on lower esophageal sphincter tone? - Answer (click here)
11. What would be an acceptable anesthetic plan for this patient? - Answer (click here)

Liver Disease

1. Liver Disease - Answer (click here)
2. Describe the basic hepatic functions that are of immediate concern to anesthesiologists - Answer (click here)
3. Explain the liver’s detoxifying and first-pass, metabolic functions - Answer (click here)
4. Describe common extrahepatic problems associated with chronic liver failure - Answer (click here)
5. What should a preoperative evaluation of this patient include? - Answer (click here)
6. What effects do surgery and anesthesia have on normal liver function? - Answer (click here)
7. What are the concerns associated with viral hepatitis? - Answer (click here)
8. Describe acetaminophen- and halothane-associated hepatitis - Answer (click here)
9. Is nitrous oxide, enflurane, or isoflurane hepatotoxic? - Answer (click here)
10. List the causes of postoperative hepatic dysfunction - Answer (click here)
11. Are some anesthetic techniques free of hepatotoxic effects? - Answer (click here)
12. What coagulation problems are anticipated and how are they managed? - Answer (click here)
13. What intraoperative anesthetic problems occur during liver transplantation? - Answer (click here)

Abdominal Aortic Aneurysm

1. Abdominal Aortic Aneurysm - Answer (click here)
2. What is the natural history of untreated abdominal aortic aneurysm (AAA)? - Answer (click here)
3. Outline the preoperative evaluation of the patient with an AAA - Answer (click here)
4. Which anesthetic techniques are appropriate for AAA surgery? - Answer (click here)
5. Which monitoring devices are recommended for AAA surgery? - Answer (click here)
6. Explain the hemodynamic consequences of aortic cross-clamping - Answer (click here)
7. Describe the options for postoperative analgesia - Answer (click here)

Endovascular Aortic Stent Placement

1. Endovascular Aortic Stent Placement - Answer (click here)
2. Explain the concept of endovascular aortic repair - Answer (click here)
3. What are the recognized perioperative surgical com-plications associated with endovascular repairs? - Answer (click here)
4. What are the outcomes following thoracic endovascular aortic repair? - Answer (click here)
5. What anesthetic techniques are used for endovascular graft insertions? - Answer (click here)
6. What problems are anticipated during proximal graft deployment? - Answer (click here)
7. Explain the special role of transesophageal echocar-diography in endovascular stent placement - Answer (click here)
8. Is the incidence of spinal cord ischemia different after endovascular thoracic aortic repairs compared to open repairs? - Answer (click here)
9. What is the “post-implantation syndrome”? - Answer (click here)

Transurethral Resection of the Prostate

1. Transurethral Resection of the Prostate - Answer (click here)
2. Describe the TURP syndrome and its treatment - Answer (click here)
3. What other complications can occur during a TURP? - Answer (click here)
4. What types of irrigating fluids have been used for a TURP? - Answer (click here)
5. What are the toxicities associated with glycine? - Answer (click here)
6. What are the anesthetic options for a patient under-going a TURP? - Answer (click here)
7. If a regional anesthetic is selected, what level of anesthesia is required? - Answer (click here)
8. How would one correct the Na+ level to 135 mEq/L? - Answer (click here)

Morbid Obesity

1. Morbid Obesity - Answer (click here)
2. How is morbid obesity (MO) defined? - Answer (click here)
3. Name the diseases associated with MO - Answer (click here)
4. Describe the pathophysiology of obstructive sleep apnea - Answer (click here)
5. How is obstructive sleep apnea diagnosed? - Answer (click here)
6. Outline the effect of MO on functional residual capacity - Answer (click here)
7. Is MO an indication for awake intubation? - Answer (click here)
8. What special equipment does the anesthesiologist require to anesthetize patients for bariatric surgery? - Answer (click here)
9. Describe an anesthetic plan for bariatric surgery - Answer (click here)

Laparoscopy

1. Laparoscopy - Answer (click here)
2. What procedures are amenable to the laparoscopic technique? - Answer (click here)
3. How is laparoscopy initiated? - Answer (click here)
4. Why is carbon dioxide (CO2) the gas used for insufflation? - Answer (click here)
5. What are the cardiovascular changes associated with laparoscopic surgery? - Answer (click here)
6. What are the regional circulatory changes that occur during laparoscopy? - Answer (click here)
7. What are the pulmonary effects associated with laparoscopic surgery? - Answer (click here)
8. What are the benefits of laparoscopic surgery? - Answer (click here)
9. What are the complications of laparoscopic surgery? - Answer (click here)
10. What anesthetic techniques can be used for laparo-scopic surgery? - Answer (click here)
11. What is the controversy regarding the use of nitrous oxide? - Answer (click here)
12. What is the etiology and treatment of post-laparoscopy pain? - Answer (click here)

Carcinoid Syndrome

1. Carcinoid Syndrome - Answer (click here)
2. What are carcinoid tumors? - Answer (click here)
3. What is carcinoid syndrome? - Answer (click here)
4. In what locations do carcinoid tumors occur? - Answer (click here)
5. What are the major anesthetic concerns in patients with carcinoid syndrome? - Answer (click here)
6. What is the mechanism of action of somatostatin? - Answer (click here)
7. What precautions are prudent for anesthetizing patients with carcinoid syndrome? - Answer (click here)
8. How is chemoem bolization used to treat metastatic carcinoid syndrome? - Answer (click here)

Kidney Transplantation

1. Kidney Transplantation - Answer (click here)
2. How does diabetes affect renal transplantation? - Answer (click here)
3. Why is timing of hemodialysis important for renal transplantation? - Answer (click here)
4. Discuss the treatment of hyperkalemia and its associated metabolic problems - Answer (click here)
5. What are the major anesthetic concerns for renal transplantation? - Answer (click here)
6. What are the implications of long ischemic times during renal transplantation? - Answer (click here)

Open Eye Injury And Intraocular Pressure

1. What is the mechanism by which intraocular pressure (IOP) is normally maintained? - Answer (click here)
2. What pathologic conditions constitute a true ocular emergency versus a relative urgency? - Answer (click here)
3. How does one minimize the deleterious side-effects of these agents in the presence of a rup-tured globe? - Answer (click here)
4. What non-anesthetic agents might the ophthalmolo-gist use to maximize surgical outcome? - Answer (click here)

Retinal Detachment

1. What are the advantages and disadvantages of general anesthesia for scleral buckle repair? - Answer (click here)
2. Describe the oculocardiac reflex and its treatment - Answer (click here)
3. What are the potential complications of retrobulbar anesthesia? - Answer (click here)
4. What types of retinal detachments are amenable to elective repair? - Answer (click here)
5. Briefly describe the series of events that occur during retinal detachment surgery - Answer (click here)
6. Reattachment of the retina requires intraocular gas - Answer (click here)

Tympanomastoidectomy

1. Is the anxious patient a good candidate for surgery under monitored anesthesia care (MAC)? - Answer (click here)
2. What general anesthetic techniques are most likely to minimize postopertive nausea and vomiting? - Answer (click here)
3. Are regional anesthetics less likely to result in PONV in this patient? - Answer (click here)
4. Why is control of blood loss important during middle ear surgery? - Answer (click here)
5. Are long-acting neuromuscular blockers contraindi-cated in middle ear surgery? - Answer (click here)
6. Describe the conduction of general and regional anesthesia for middle ear surgery - Answer (click here)

The Difficult Airway

1. What are the predictors of difficult mask ventilation? - Answer (click here)
2. Discuss the risk factors for difficult intubation - Answer (click here)
3. Are the risk factors for difficult intubation reliable predictors of difficult intubation? - Answer (click here)
4. How is the anticipated difficult intubation approached? - Answer (click here)
5. Describe the management options for a patient who, after induction of anesthesia - Answer (click here)
6. Following induction of anesthesia, ventilation by facemask and intubation are impossible. What maneuvers may help? - Answer (click here)
7. How is successful tracheal intubation verified? - Answer (click here)
8. Following a difficult intubation, how is postoperative extubation managed? - Answer (click here)

Adenotonsillectomy

1. What are the indications and contraindications for adenotonsillectomy? - Answer (click here)
2. Describe the essential elements of preoperative evaluation for adenotonsillectomy - Answer (click here)
3. How is the patient premedicated for adenotonsillectomy? - Answer (click here)
4. What anesthetic alternatives are available for patients undergoing adenotonsillectomy? - Answer (click here)
5. What are the common postanesthesia care unit problems anticipated following adenotonsillectomy? - Answer (click here)
6. Which patients are suitable candidates for ambulatory adenotonsillectomy? - Answer (click here)
7. Describe the anesthetic management of a patient presenting with post-tonsillectomy hemorrhage - Answer (click here)

Laser Laryngoscopy

1. What is a laser? - Answer (click here)
2. Describe the most common types of lasers used in medical practice - Answer (click here)
3. Which lasers are used in laryngeal and tracheobronchial surgery? - Answer (click here)
4. What are the indications for laser laryngoscopy? - Answer (click here)
5. What are the hazards of laser laryngoscopy to patients, operating room personnel, and anesthesia equipment? - Answer (click here)
6. What anesthetic techniques are appropriate for patients undergoing laser laryngoscopy? - Answer (click here)
7. What maneuvers are instituted to treat an airway fire? Is the risk of fire any less likely with electrocautery? - Answer (click here)

Transfusion Reaction

1. How are standards for transfusion practice developed? - Answer (click here)
2. What steps should be taken when a transfusion reaction occurs? - Answer (click here)
3. How does the laboratory determine which direction the investigation should take? - Answer (click here)
4. How many different types of crossmatches are there and how does the laboratory decide which should be performed? - Answer (click here)
5. What are the immediate and delayed adverse effects of blood transfusion? - Answer (click here)

Intraoperative Coagulopathies

1. What should be included in the preoperative evaluation? - Answer (click here)
2. If the screening PT or aPTT are prolonged, which other laboratory tests should be ordered? - Answer (click here)
3. What are the most common intraoperative coagulopathies? - Answer (click here)
4. Which blood products are used to treat intraoperative coagulopathies? - Answer (click here)

Blood Replacement

1. How is oxygen transported by the circulatory system? - Answer (click here)
2. Describe compensatory mechanisms that take place in response to blood loss - Answer (click here)
3. What is the minimum acceptable hemoglobin concentration (transfusion trigger)? - Answer (click here)
4. List the potential sources of autologous blood - Answer (click here)
5. Explain acute isovolemic hemodilution (AIHD) - Answer (click here)
6. Outline the physiologic response to AIHD - Answer (click here)
7. How is AIHD accomplished? - Answer (click here)
8. Which patients are suitable candidates for AIHD? - Answer (click here)
9. What is intraoperative cell salvage and how do modern cell salvage devices work? - Answer (click here)
10. Outline the characteristics of blood obtained by cell salvage - Answer (click here)
11. Describe the indications for use of intraoperative cell salvage - Answer (click here)
12. Explain the controversies and contraindications involving intraoperative cell salvage - Answer (click here)
13. What is preoperative autologous blood donation (PABD)? - Answer (click here)
14. Who is eligible and what are the contraindications for PABD? - Answer (click here)
15. Outline the disadvantages and risks of PABD - Answer (click here)
16. Describe postoperative blood salvage - Answer (click here)
17. Explain the advantages and disadvantages of different autologous blood sources - Answer (click here)

The Jehovahs Witness Patient

1. What is scoliosis? - Answer (click here)
2. How is scoliosis classified? - Answer (click here)
3. How is the curvature assessed in the patient with scoliosis? - Answer (click here)
4. On the issue of blood, what will a JW refuse and accept? - Answer (click here)
5. What are the medicolegal issues concerning blood transfusion in the JW who is a minor? - Answer (click here)
6. Describe the preoperative evaluation of the patient with scoliosis - Answer (click here)
7. Describe the intraoperative anesthetic considerations for posterior spinal fusion surgery - Answer (click here)
8. What is the “wake-up test”? - Answer (click here)
9. Describe the postoperative anesthetic concerns following scoliosis repair - Answer (click here)
10. What blood substitutes are available? - Answer (click here)

Hemophilia A

1. What is the primary deficiency in hemophilia A? - Answer (click here)
2. How does the disease present and what are the laboratory findings? - Answer (click here)
3. What is the role of factor VIII in the coagulation process? - Answer (click here)
4. Describe the treatment options - Answer (click here)
5. Discuss von Willebrand disease as another important cause of surgical bleeding - Answer (click here)

Total Hip Replacement

1. Briefly describe rheumatoid arthritis and its treatment - Answer (click here)
2. What are the anesthetic considerations for the rheumatoid arthritis patient? - Answer (click here)
3. How is the rheumatoid arthritis patient evaluated for anesthesia? - Answer (click here)
4. Discuss the options for induction of anesthesia in a primary hip arthroplasty - Answer (click here)
5. Several hours into the case the surgeon complains that he is operating on a moving target. How would you manage this situation? - Answer (click here)
6. Discuss the causes and management of fat embolus syndrome - Answer (click here)
7. Discuss thromboembolism prophylaxis and the placement of neuraxial anesthesia - Answer (click here)
8. Discuss the options for postoperative pain control after total hip arthroplasty. Discuss the use of a lumbar plexus block - Answer (click here)

Local Anesthetics

1. Describe the chemistry of local anesthetics - Answer (click here)
2. Describe the mechanism of action of local anesthetics - Answer (click here)
3. What factors affect the potency, onset, and duration of action of local anesthetics? - Answer (click here)
4. Discuss the sequence of clinical anesthesia following neural blockade - Answer (click here)
5. What are the clinical differences between the ester and amide local anesthetics? - Answer (click here)
6. Describe the pharmacokinetics of local anesthetics - Answer (click here)
7. How do factors such as dosage of local anesthetic, addition of vasoconstrictors, carbonation and pH adjustment - Answer (click here)
8. Which local anesthetics are appropriate for the various regional anesthetic procedures? - Answer (click here)
9. Describe the toxic effects of local anesthetics - Answer (click here)
10. How is systemic local anesthetic toxicity treated? - Answer (click here)
11. Is it prudent to use regional anesthesia in a patient who reports a Novocain allergy? - Answer (click here)
12. What is the treatment for local anesthetic allergic reactions? - Answer (click here)

Spinal Anesthesia

1. Other than the spinal kit, what equipment must be immediately available while performing spinal anesthesia? - Answer (click here)
2. When arranging the spinal tray, where is the antiseptic placed in relation to the tray’s other constituents? - Answer (click here)
3. What are the advantages of the lateral decubitus position for placing a subarachnoid block? - Answer (click here)
4. What are the advantages of the sitting position for placing a subarachnoid block? - Answer (click here)
5. Describe a technique for placing a spinal anesthesia - Answer (click here)
6. Describe alternative approaches to the subarachnoid space - Answer (click here)
7. What factors affect the spread of anesthetic within the subarachnoid space? - Answer (click here)
8. What agents are commonly used for subarachnoid block? - Answer (click here)
9. Besides local anesthetics, what other agents are administered in the subarachnoid space? - Answer (click here)
10. What are the advantages of adding a vasoconstrictor to the spinal anesthetic solution? - Answer (click here)
11. What are the recognized complications of spinal anesthesia? - Answer (click here)
12. What are the contraindications to spinal anesthesia? - Answer (click here)
13. Describe the advantages of spinal anesthesia over general anesthesia - Answer (click here)
14. Explain the advantages of spinal anesthesia over epidural anesthesia - Answer (click here)
15. Outline the advantages and disadvantages of catheter (continuous) spinal anesthesia - Answer (click here)

Brachial Plexus Anesthesia

1. Describe the anatomic course of the brachial plexus - Answer (click here)
2. What are the anatomic landmarks of the axilla? - Answer (click here)
3. What are the major approaches to blocking the brachial plexus and their indications for use? - Answer (click here)
4. Describe the interscalene approach to blocking the brachial plexus - Answer (click here)
5. Describe the supraclavicular approach to blocking the brachial plexus - Answer (click here)
6. Describe the infraclavicular approach to blocking the brachial plexus - Answer (click here)
7. Describe the axillary approach to blocking the brachial plexus - Answer (click here)
8. What complications can arise from upper extremity blocks? - Answer (click here)
9. What is the Bezold-Jarisch reflex? - Answer (click here)
10. What local anesthetics are used for blocks of the brachial plexus and in what doses? - Answer (click here)
11. Is chronic obstructive pulmonary disease (COPD) a contraindication to performing an interscalene block? - Answer (click here)

Lower Extremity Anesthesia

1. What are the anesthetic options for this patient? - Answer (click here)
2. What are the advantages and disadvantages of the various anesthetic options? - Answer (click here)
3. Describe the innervation of the lower extremity - Answer (click here)
4. Why is a sciatic nerve block necessary for adequate anesthesia for a total knee arthroplasty? - Answer (click here)
5. How are femoral and sciatic nerve blocks performed? Which local anesthetic agents would you use? - Answer (click here)
6. Would you sedate the patient for the performance of the femoral and sciatic nerve blocks and/or during the procedure? - Answer (click here)
7. After performing the block and starting a propofol infusion, the patient begins to flail about upon surgical incision. Should you induce general anesthesia? - Answer (click here)
8. Describe the use of the tourniquet in a total knee arthroplasty and its hemodynamic consequences - Answer (click here)
9. What are the options for postoperative pain control? - Answer (click here)

Labor And Delivery

1. What options are available to the mother for labor analgesia? - Answer (click here)
2. Explain the advantages and disadvantages of various regional anesthetic techniques for labor and delivery - Answer (click here)
3. What is a “walking epidural”? - Answer (click here)
4. Describe the regional anesthetic techniques that can be employed for cesarean section - Answer (click here)
5. Outline the treatment for postdural puncture headache - Answer (click here)
6. What are the advantages and disadvantages of general anesthesia for cesarean section? - Answer (click here)
7. Describe the elements of placental drug transfer - Answer (click here)
8. What techniques can be used for post-cesarean pain relief? - Answer (click here)
9. Outline the differential diagnosis of postpartum hemorrhage - Answer (click here)
10. Explain the risk factors, presentation, and treatment of uterine atony - Answer (click here)
11. Describe the presentation and treatment of retained placenta - Answer (click here)

Preeclampsia

1. Classify the hypertensive disorders of pregnancy - Answer (click here)
2. What are the incidence and risk factors of preeclampsia? - Answer (click here)
3. Explain the etiology of preeclampsia - Answer (click here)
4. Describe the pathophysiology of preeclampsia - Answer (click here)
5. Outline the obstetric management of preeclampsia - Answer (click here)
6. How is preeclampsia prevented from degenerating into eclampsia? - Answer (click here)
7. Explain the management of preeclampsia-related hypertension - Answer (click here)
8. What are the potential consequences of epidural anesthesia in the patient with preeclampsia? - Answer (click here)
9. Describe the anesthetic options for cesarean section for the preeclamptic patient - Answer (click here)
10. Outline the anticipated postpartum problems associated with preeclampsia - Answer (click here)

Abruptio Placenta and Placenta Previa

1. Summarize the major causes of third-trimester bleeding - Answer (click here)
2. What is abruptio placenta and what are its risk factors? - Answer (click here)
3. What are the presenting signs and symptoms of abruptio placenta and how is the diagnosis made? - Answer (click here)
4. Describe the obstetric management of abruptio placenta - Answer (click here)
5. Describe the effects of pregnancy on coagulation - Answer (click here)
6. What is disseminated intravascular coagulopathy and how is it managed? - Answer (click here)
7. How is fetal distress diagnosed? - Answer (click here)
8. The patient is given a trial of labor, and the obstetrician requests a consult for labor analgesia. What are your concerns and how would you proceed? - Answer (click here)
9. How would you anesthetize this patient for an emergency cesarean section? - Answer (click here)
10. What is placenta previa? - Answer (click here)
11. What is the clinical presentation of placenta previa and how is the diagnosis made? - Answer (click here)
12. What is the obstetric management of placenta previa? - Answer (click here)
13. How would you anesthetize the patient with placenta previa for cesarean section? - Answer (click here)

Anesthesia For Nonobstetric Surgery During Pregnancy

1. What is the incidence of nonobstetric surgery in the pregnant patient? - Answer (click here)
2. What are the anesthetic concerns when anesthetizing a pregnant patient? - Answer (click here)
3. What are the physiologic changes during pregnancy and how do they impact on anesthesia? - Answer (click here)
4. What is a teratogen and which anesthetic agents are known teratogens? - Answer (click here)
5. What precautions should be taken to avoid intrauterine fetal asphyxia? - Answer (click here)
6. How is preterm labor prevented? - Answer (click here)
7. What monitors should be used when anesthetizing the pregnant patient? - Answer (click here)
8. What are the special considerations for laparoscopic surgery? - Answer (click here)
9. What general recommendations can be made when anesthetizing the pregnant patient for nonobstetric surgery? - Answer (click here)

Thrombocytopenia In Pregnancy

1. What are the concerns when placing an epidural catheter if the platelet count is low? - Answer (click here)
2. Who is at risk for developing an epidural hematoma? - Answer (click here)
3. What is considered a low platelet count from the perspective of epidural catheter placement? - Answer (click here)
4. What is the expected platelet count during pregnancy? - Answer (click here)
5. Describe coagulation and the role that platelets play in the process - Answer (click here)
6. What are the causes of thrombocytopenia during pregnancy? - Answer (click here)
7. What tests are available to evaluate platelet function? - Answer (click here)
8. Describe the bleeding time test and its limitation - Answer (click here)
9. Describe the thromboelastogram and its limitations - Answer (click here)
10. Describe the platelet function analyzer and its limitations - Answer (click here)
11. What is the overall risk of epidural hematoma? - Answer (click here)
12. Describe the known cases in the literature of epidural hematoma in the parturient - Answer (click here)
13. What is the evidence that initiating an epidural anesthetic in a woman with a platelet count <100,000 mm−3 may be safe? - Answer (click here)
14. How do you evaluate the patient who has a platelet count <100,000 mm−3? - Answer (click here)
15. What are some practical recommendations regard-ing neuraxial anesthesia in the parturient who presents with a low platelet count? - Answer (click here)
16. What is low-molecular-weight heparin (LMWH) and how does it compare with and differ from standard heparin? - Answer (click here)
17. Why do some pregnant women take LMWH? - Answer (click here)
18. What has been the anesthetic experience with LMWH and neuraxial anesthesia? - Answer (click here)
19. What are some of the unique recommendations for anesthetizing the parturient taking LMWH? - Answer (click here)

Neonatal Resuscitation

1. Describe the fetal circulation - Answer (click here)
2. What are the physiologic changes that occur at birth? - Answer (click here)
3. How is neonatal resuscitation managed in the delivery room? - Answer (click here)
4. What is the Apgar score? - Answer (click here)

Gastroschisis and Omphalocele

1. What are the differences between gastroschisis and omphalocele? - Answer (click here)
2. How is this neonate managed preoperatively? - Answer (click here)
3. How is the operating room prepared for this newborn? - Answer (click here)
4. What is the anesthetic plan, and what are the intra-operative and postoperative concerns in this patient? - Answer (click here)
5. Describe the fluid and blood product management for this neonate intraoperatively - Answer (click here)

Congenital Diaphragmatic Hernia

1. Describe the embryology and pathophysiology of congenital diaphragmatic hernia (CDH) - Answer (click here)
2. What are the clinical features of CDH? - Answer (click here)
3. How is CDH diagnosed? - Answer (click here)
4. What is the preoperative management of CDH? - Answer (click here)
5. What is permissive hypercapnia? - Answer (click here)
6. What are the anesthetic considerations for the neonate with CDH? - Answer (click here)
7. What problems may occur intraoperatively and postoperatively? - Answer (click here)
8. Describe the techniques for fetal surgery - Answer (click here)

Pyloric Stenosis

1. What is pyloric stenosis? - Answer (click here)
2. What is the clinical presentation of pyloric stenosis? - Answer (click here)
3. How is the diagnosis made? - Answer (click here)
4. What are the metabolic derangements and how are they treated? - Answer (click here)
5. What is the surgical treatment of pyloric stenosis? - Answer (click here)
6. What are the anesthetic considerations? - Answer (click here)

Tracheoesophageal Fistula

1. What is a tracheoesophageal fistula (TEF)? - Answer (click here)
2. How does a patient with a TEF typically present? - Answer (click here)
3. What are the preoperative concerns in a patient with TEF? - Answer (click here)
4. How is the patient with a TEF managed intraoperatively? - Answer (click here)
5. What are the postoperative concerns in TEF patients? - Answer (click here)

Congenital Heart Disease

1. How are innocent and pathologic systolic murmurs differentiated? - Answer (click here)
2. What is the incidence of congenital heart disease? - Answer (click here)
3. What are the general anesthetic considerations for the common cardiac lesions? - Answer (click here)
4. What should be included in the preoperative assessment? - Answer (click here)
5. What are the anesthetic implications of intracardiac lesions with left-to-right shunting? - Answer (click here)
6. What are the common intracardiac left-to-right shunting lesions? - Answer (click here)
7. What are the anesthetic implications of right-to-left shunting lesions? - Answer (click here)
8. What are the common right-to-left shunting lesions with reduced pulmonary blood flow? - Answer (click here)
9. How are congenital heart lesions repaired? - Answer (click here)
10. Discuss the sequelae associated with the repair of specific cardiac lesions - Answer (click here)

Preterm Infant

1. What are the anatomic and physiologic differences between the infant and the adult? - Answer (click here)
2. What is the definition of prematurity? - Answer (click here)
3. Do the pharmacokinetics and pharmacodynamics of anesthetic drugs differ in this population as compared with adults? - Answer (click here)
4. What are the nil per os (NPO) guidelines for this case? - Answer (click here)
5. What anesthetic options are available and what are the concerns regarding each option? - Answer (click here)
6. If a general anesthetic is planned, what are the induction options? - Answer (click here)
7. What are the appropriate monitors for this case? - Answer (click here)
8. What are the options for postoperative pain control? - Answer (click here)
9. When can this infant be discharged home? Could this procedure have been done as an outpatient after discharge? - Answer (click here)

MRI and the Down Syndrome Child

1. What is magnetic resonance imaging (MRI)? - Answer (click here)
2. What are the magnetic field problems associated with MRI? - Answer (click here)
3. What are the specific problems encountered with physiologic monitors and equipment in the MRI suite? - Answer (click here)
4. What are possible patient problems encountered in the MRI scanner? - Answer (click here)
5. What are the clinical manifestations of Down syndrome? - Answer (click here)
6. Describe the pre-anesthetic evaluation of the child with Down syndrome - Answer (click here)
7. What anesthetic alternatives are available for the child with Down syndrome undergoing MRI? - Answer (click here)
8. Describe the postanesthetic concerns in the child with Down syndrome after MRI - Answer (click here)

Acute Postoperative Pain

1. Why has postoperative pain been undertreated in the past? - Answer (click here)
2. Which factors in this patient’s history may impact on postoperative pain management? - Answer (click here)
3. Which organ systems are affected by postoperative pain? - Answer (click here)
4. Outline the major afferent pain pathways - Answer (click here)
5. What are the primary chemical mediators of pain? - Answer (click here)
6. What are the advantages and disadvantages of intramuscular opioid therapy? - Answer (click here)
7. List alternative postoperative analgesic modalities for this patient - Answer (click here)
8. What is patient-controlled analgesia (PCA)? - Answer (click here)
9. What are typical dosage schedules for intravenous PCA-administered opioids? - Answer (click here)
10. Compare the advantages and disadvantages of PCA opioids with those of intramuscular opioids - Answer (click here)
11. Describe the regional analgesic techniques available for postoperative pain relief. Which are applicable to this patient? - Answer (click here)
12. By what mechanism does neuraxial (epidural and subarachnoid) opioid administration produce analgesia? - Answer (click here)
13. Outline the potential side-effects of neuraxial opioids and their treatment - Answer (click here)
14. Describe the advantages and disadvantages of subarachnoid and epidural opioids - Answer (click here)
15. Which opioids and adjuvants are commonly used in the subarachnoid and epidural spaces? - Answer (click here)
16. What is preemptive analgesia? Can it reliably be performed in this patient? - Answer (click here)

Low Back Pain

1. What is the incidence of low back pain? - Answer (click here)
2. List the differential diagnosis of low back pain - Answer (click here)
3. Describe the classic presentation of a patient with a herniated nucleus pulposus - Answer (click here)
4. Differentiate the clinical presentation of a herniated nucleus pulposus from spinal stenosis - Answer (click here)
5. Describe the pathogenesis and treatment of myofascial syndrome (trigger points) - Answer (click here)
6. What are the signs and symptoms of sacroiliac disease and how is it treated? - Answer (click here)
7. What are the facet joints and how does pathology in them manifest? - Answer (click here)
8. What is the mechanism of action by which epidural steroid injections work? - Answer (click here)
9. What are the pathogenesis, diagnosis, and treatment of internal disc disruption (IDD)? - Answer (click here)
10. Which oral medications are prescribed for low back pain? - Answer (click here)
11. What is failed back syndrome (FBS) and how is it managed? - Answer (click here)

Postherpetic Neuralgia

1. What is the pathogenesis of an acute herpes zoster infection? - Answer (click here)
2. How does an acute herpes zoster infection manifest itself? - Answer (click here)
3. What is postherpetic neuralgia (PHN)? - Answer (click here)
4. Which patients are at risk for the development of PHN? - Answer (click here)
5. How does PHN present? - Answer (click here)
6. What medications can be used for treatment of PHN? What is the mechanism of action of these medications? - Answer (click here)
7. What invasive procedures can be used for the treatment of PHN? - Answer (click here)
8. Can PHN be prevented? - Answer (click here)

Complex Regional Pain Syndrome

1. Define complex regional pain syndrome (CRPS) type 1 and type 2 - Answer (click here)
2. What are the pathophysiologic theories leading to CRPS? - Answer (click here)
3. Delineate the different stages of CRPS - Answer (click here)
4. What are the signs and symptoms of CRPS? - Answer (click here)
5. How is the diagnosis of CRPS made? - Answer (click here)
6. What different nerve blocks can be used for diagnosis and treatment of CRPS? - Answer (click here)
7. What other modalities can be used to treat CRPS? - Answer (click here)

Cancer Pain Management

1. What is the prevalence of cancer pain? - Answer (click here)
2. What is the prevalence of cancer pain by organ system? - Answer (click here)
3. What are the different causes of pain in a cancer patient? - Answer (click here)
4. What is the WHO ladder? - Answer (click here)
5. What guidelines can be followed in devising a chronic analgesic regimen for treating cancer pain? - Answer (click here)
6. What are the advantages of set-dose extended-duration opioid management? - Answer (click here)
7. Describe the anatomy of the celiac plexus - Answer (click here)
8. What are the indications for performing a celiac plexus block? - Answer (click here)
9. How is a celiac plexus block performed and what complications can occur? - Answer (click here)
10. What are the differences between alcohol and phenol neurolysis? - Answer (click here)
11. When would one use intrathecal versus epidural analgesia for cancer pain management? - Answer (click here)

Ambulatory Surgery

1. Are there advantages to performing surgery on an ambulatory basis? - Answer (click here)
2. Which patients are considered acceptable candidates for ambulatory surgery? - Answer (click here)
3. Are there any patients who should never have surgery on an ambulatory basis? - Answer (click here)
4. Are diabetic patients suitable candidates for ambulatory surgery? - Answer (click here)
5. What types of surgical procedures are appropriate for ambulatory surgery? - Answer (click here)
6. What is the appropriate fasting time before ambulatory surgery that necessitates an anesthetic? - Answer (click here)
7. Should drugs be administered to empty the stomach or change gastric acidity or volume before the administration of an anesthetic? - Answer (click here)
8. How can patients be appropriately screened for anesthesia when ambulatory surgery is planned? - Answer (click here)
9. What preoperative laboratory studies should be obtained before surgery? - Answer (click here)
10. Should an internist evaluate each patient before ambulatory surgery? - Answer (click here)
11. Is anxiolytic premedication advisable before ambulatory surgery, and what agents are appropriate? - Answer (click here)
12. What are the reasons for last-minute cancellation or postponement of surgery? - Answer (click here)
13. What is the ideal anesthetic for ambulatory surgery? - Answer (click here)
14. Are there relative or absolute contraindications to the administration of a general anesthetic in the ambulatory setting? - Answer (click here)
15. What are the advantages and disadvantages to performing a conduction anesthetic in the ambulatory patient? - Answer (click here)
16. What are the advantages and disadvantages of selecting a nerve block technique for the ambulatory patient? - Answer (click here)
17. Describe the intravenous regional anesthetic technique (Bier block) for surgery on the extremities - Answer (click here)
18. What sedatives can be administered to supplement a regional anesthetic? - Answer (click here)
19. What complications of nerve block anesthesia are of special concern to the ambulatory patient? - Answer (click here)
20. Should patients having ambulatory surgery be tracheally intubated? - Answer (click here)
21. What is the role of propofol in ambulatory surgery? - Answer (click here)
22. What is total intravenous anesthesia (TIVA), and what are its advantages and disadvantages? - Answer (click here)
23. What is moderate sedation, when is it employed, and what advantages does it offer? - Answer (click here)
24. When tracheal intubation is required for a short procedure, can one avoid the myalgias associated with succinylcholine? - Answer (click here)
25. Can a relative overdose of benzodiazepines be safely antagonized? - Answer (click here)
26. Do the newer volatile agents offer advantages over older agents such as enflurane and isoflurane? - Answer (click here)
27. What are the etiologies of nausea and vomiting, and what measures can be taken to decrease their incidence and severity? - Answer (click here)
28. How is pain best controlled in the ambulatory patient in the PACU? - Answer (click here)
29. What discharge criteria must be met before a patient may leave the ambulatory surgery center? - Answer (click here)
30. What are the causes of unexpected hospitalization following ambulatory surgery? - Answer (click here)
31. When may patients operate a motor vehicle after receiving a general anesthetic? - Answer (click here)
32. What is the role of aftercare centers for the ambulatory surgery patient? - Answer (click here)
33. Are quality assurance and continuous quality improvement possible for ambulatory surgery? - Answer (click here)

Office Based Anesthesia

1. Why have office-based procedures and anesthesia services grown so rapidly? - Answer (click here)
2. What do you need to consider before providing office-based anesthesia (OBA)? - Answer (click here)
3. What equipment is necessary to provide safe OBA? Is it the same as for the hospital setting? - Answer (click here)
4. Are there any differences in record keeping or documentation as compared with the hospital setting? - Answer (click here)
5. Does the history of malignant hyperthermia preclude an office-based procedure and anesthesia? - Answer (click here)
6. Are there any limitations set for types of patients/ procedures for office-based surgery? - Answer (click here)
7. What method/technique would you choose to provide anesthesia? - Answer (click here)
8. How will you treat postoperative nausea and vomiting (PONV)? - Answer (click here)
9. How will you determine when the patient is ready to be discharged? - Answer (click here)

Thoracic Trauma

1. What are the consequences of thoracic trauma? - Answer (click here)
2. How are traumatic pneumothorax and/or hemothorax managed in a patient undergoing laparotomy for splenic injury? - Answer (click here)
3. What are the mechanisms of morbidity and mortality from flail chest? - Answer (click here)
4. What are the management options for flail chest and pulmonary contusion? - Answer (click here)
5. What are the perioperative management options for traumatic hemopericardium? - Answer (click here)
6. What are the clinical implications of blunt cardiac trauma? - Answer (click here)
7. When should traumatic thoracic aortic injury be suspected and how is the diagnosis made? - Answer (click here)
8. In blunt trauma patients with multiple injuries that include thoracic aortic injury, how is surgery prioritized? - Answer (click here)
9. What are the perioperative clinical and anesthetic pitfalls - Answer (click here)
10. Describe the clinical management of transmediastinal gunshot wounds - Answer (click here)

Asthma

1. What is asthma? - Answer (click here)
2. How is asthma classified? - Answer (click here)
3. How would you distinguish obstructive from restrictive lung disease, and asthma from chronic obstructive pulmonary disease (COPD) - Answer (click here)
4. Briefly describe the pharmacology of medications available to treat asthma. - Answer (click here)
5. What are the indications for mechanical ventilation in severe asthma (status asthmaticus)? - Answer (click here)
6. What preoperative evaluation and preparation would you order for this patient? - Answer (click here)
7. Would you choose general anesthesia (with endotra-cheal intubation, with a laryngeal mask airway) or a neuraxial block for this patient? -Answer (click here)
8. What are the signs and causes of perioperative bronchospasm? - Answer (click here)
9. The patient refused to have “a needle stuck in her back” - Answer (click here)

Shock

1. What are the determinants of blood pressure? - Answer (click here)
2. How should postoperative hypotension be approached? - Answer (click here)
3. What is the definition of shock? - Answer (click here)
4. What are the different types of shock and the basics of treatment for each type? What would you do for this patient? - Answer (click here)
5. A pulmonary artery catheter (PAC) was inserted - Answer (click here)
6. What is the classification of hemorrhage according to the American College of Surgeons? - Answer (click here)
7. The heart rate suddenly goes up to 170 beats per minute with wide QRS complexes and the blood pressure drops further. What are the diagnostic possibilities? - Answer (click here)
8. What are the treatment options for each of the discussed dysrhythmias? What would you do for this patient? - Answer (click here)

Bradycardia and Hypertension

1. What is the differential diagnosis of bradycardia? What is the treatment for the different types of bradycardia? - Answer (click here)
2. What is the differential diagnosis of postoperative hypertension? - Answer (click here)
3. What intravenous agents may be administered to treat hypertension? - Answer (click here)

Hypothermia

1. How is hypothermia defined and graded? - Answer (click here)
2. What mechanisms lead to hypothermia in a patient under general anesthesia in the operating room? - Answer (click here)
3. What are the physiologic responses to hypothermia? - Answer (click here)
4. What are the physiologic consequences of hypothermia? - Answer (click here)
5. Are there any benefits to mild intraoperative hypothermia? - Answer (click here)
6. What are the different sites at which temperature can be monitored? - Answer (click here)
7. What are the modalities to prevent and treat perioperative hypothermia? - Answer (click here)
8. Is prevention of hypothermia warranted in a patient who received a central neuraxial block? - Answer (click here)

Postanesthesia Care Unit Discharge Criteria

1. What is the cause of nausea and vomiting? - Answer (click here)
2. What are the risk factors for postoperative nausea and vomiting (PONV)? - Answer (click here)
3. What is the incidence and importance of nausea and vomiting after anesthesia and surgery? - Answer (click here)
4. What are the treatment options available for PONV? - Answer (click here)
5. What are the main complications occurring in the postanesthesia care unit (PACU)? - Answer (click here)
6. What are the discharge criteria for discharge from the PACU? - Answer (click here)

Respiratory Failure

1. How is postoperative respiratory failure defined? What are the two main types of acute respiratory failure? - Answer (click here)
2. What are the four primary causes of hypoxemia and how are they distin-guished? Which is most likely in this patient, and how would you treat it? - Answer (click here)
3. how would this ABG be interpreted? What treatment should be prescribed? - Answer (click here)
4. How would you manage this patient? - Answer (click here)
5. Briefly describe the most common ventilatory modes - Answer (click here)
6. What criteria are used to determine whether extubation will be successful? - Answer (click here)

Delayed Emergence Coma and Brain Death

1. What are the possible causes, investigation, and treatment for delayed emergence from anesthesia? - Answer (click here)
2. How would you manage this patient in the intensive care unit? - Answer (click here)
3. What is your response? What are the criteria for brain death? - Answer (click here)

Anaphylaxis

1. What is the mechanism of anaphylaxis? What is the difference between anaphylactic and anaphylactoid reactions? - Answer (click here)
2. What treatment should be administered to this patient? What else should be checked on physical examination? - Answer (click here)
3. What are the medications most often implicated in anaphylaxis? In anaphylactoid reactions? - Answer (click here)
4. What is the percentage of patients allergic to penicillin who will have a reaction when challenged with a cephalosporin? - Answer (click here)
5. Should surgery be allowed to proceed or should the case be cancelled? What will you tell the patient postoperatively? - Answer (click here)