Iran Anesthesiology Specialty Board Exam flashcards

35 cards. Read the term and the definition here. The deck at the top of this page is optional.

MAC definition

Minimum alveolar concentration at which 50% of patients do not move in response to a standard surgical stimulus at 1 atmosphere. It reflects potency and is inversely related to lipid solubility.

Context-sensitive half-time

Time for plasma drug concentration to fall by 50% after stopping an infusion. It depends on infusion duration and redistribution, and rises markedly with prolonged thiopental or fentanyl infusions.

Pseudocholinesterase deficiency

Atypical plasma butyrylcholinesterase slows succinylcholine hydrolysis, prolonging paralysis. Dibucaine number below 20 suggests homozygous atypical enzyme; management is ventilation and sedation until recovery.

E-cylinder oxygen content

A full E-cylinder contains approximately 660 L of oxygen at 2200 psi. Remaining volume equals gauge pressure divided by 2200, multiplied by 660 L.

RCRI predictors

Six predictors: ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine above 2 mg/dL, and high-risk surgery. Three or more indicate elevated perioperative cardiac risk.

Functional capacity in METs

One MET equals 3.5 mL O2/kg/min. Climbing a flight of stairs or walking briskly approximates 4 METs, which generally permits surgery without further cardiac testing.

STOP-BANG score

Screening tool for obstructive sleep apnea: snoring, tiredness, observed apnea, pressure, BMI above 35, age above 50, neck circumference above 40 cm, male gender. Score of 3 or more indicates high risk.

ASA physical status

Classification from I (healthy) to V (moribund, not expected to survive without operation), with suffix E for emergency. It predicts perioperative risk but is not a surgical risk score.

Sugammadex dosing

Reversal of rocuronium: 2 mg/kg for moderate block with train-of-four count of 2 or more; 4 mg/kg for deep block; 16 mg/kg for immediate reversal after a 1.2 mg/kg intubating dose.

Epidural test dose

Three milliliters of lidocaine 1.5% with epinephrine 1:200,000. A heart rate rise above 20 bpm or systolic rise above 15-20 mmHg suggests unintentional intravascular placement.

Rapid sequence induction

Preoxygenation followed by a rapidly acting induction agent and neuromuscular blocker, typically succinylcholine or rocuronium 1.2 mg/kg, with cricoid pressure applied to reduce aspiration risk.

Difficult mask ventilation predictors

Age above 55, BMI above 26, edentulous state, beard, snoring, and Mallampati III or IV. Two or more predictors warrant preparation for difficult airway management.

Capnography waveform phases

Phase I is inspiratory baseline, phase II expiratory upstroke, phase III alveolar plateau, and phase IV inspiratory downstroke. The end-tidal value is measured at the end of phase III.

Pulse oximetry curve points

SpO2 of 90% corresponds to PaO2 near 60 mmHg, and 75% corresponds to about 40 mmHg. The steep portion of the curve means small PaO2 falls cause large desaturation.

Train-of-four ratio

Ratio of the fourth to first twitch in a train of four. A ratio of 0.9 or greater indicates adequate recovery; lower ratios indicate residual neuromuscular blockade and increased aspiration risk.

Pulse pressure variation

A dynamic marker of fluid responsiveness in mechanically ventilated patients. Values above 13% suggest the patient will increase stroke volume with a fluid bolus.

4-2-1 maintenance fluid rule

Hourly crystalloid maintenance: 4 mL/kg for the first 10 kg, 2 mL/kg for the next 10 kg, and 1 mL/kg for each kilogram thereafter. A 70 kg adult receives about 110 mL/h.

Cerebral perfusion pressure

CPP equals mean arterial pressure minus intracranial pressure. Typical target is 60-70 mmHg; it guides management of traumatic brain injury and intracranial hypertension.

One-lung ventilation settings

Use tidal volume 4-6 mL/kg predicted body weight, PEEP around 5 cm H2O, and permissive hypercapnia. These settings limit ventilator-induced lung injury during thoracic surgery.

Pediatric uncuffed tube size

Formula: (age in years / 4) + 4 mm for uncuffed tubes. Cuffed tubes are typically one half to one size smaller. Confirm placement by auscultation and leak pressure.

Burn patient succinylcholine risk

Beyond 24-48 hours after a major burn, upregulation of extrajunctional acetylcholine receptors causes massive potassium release with succinylcholine. Use a nondepolarizing agent instead.

Preeclampsia anesthesia

Neuraxial analgesia is preferred. Avoid abrupt hypotension; treat with phenylephrine or epinephrine and fluids. Magnesium toxicity is reversed with calcium gluconate 1 g intravenously.

Sepsis bundle

Give 30 mL/kg crystalloid for hypotension or lactate above 4 mmol/L, broad-spectrum antibiotics within one hour, and norepinephrine to maintain mean arterial pressure above 65 mmHg.

ARDS ventilator strategy

Low tidal volume 4-6 mL/kg predicted body weight, plateau pressure below 30 cm H2O, PEEP titration, and prone positioning for severe hypoxemia. These measures reduce mortality.

PONV risk factors

Female gender, nonsmoker status, history of motion sickness or PONV, and postoperative opioids. Each adds risk; multimodal prophylaxis with ondansetron, dexamethasone, and droperidol is effective.

RASS sedation target

Richmond Agitation-Sedation Scale ranges from +4 (combative) to −5 (unarousable). Target 0 to −2 in most ICU patients; daily interruption shortens ventilator days.

Renal failure drug choice

Cisatracurium undergoes organ-independent Hofmann elimination, making it suitable in renal failure. Avoid morphine and meperidine due to active metabolites; adjust renally cleared drugs.

Elderly anesthetic sensitivity

Aging reduces MAC requirement, hepatic and renal clearance, and functional reserve. Benzodiazepines and opioids cause greater sedation and respiratory depression, so titrate carefully.

OSA perioperative risk

Obstructive sleep apnea increases difficult mask ventilation and intubation risk. Use postoperative CPAP, avoid sedative premedication, and monitor for opioid-induced respiratory depression.

WHO surgical safety checklist

Three phases: sign-in before induction, time-out before incision, and sign-out before leaving the operating room. Implementation reduces surgical morbidity and mortality.

Informed consent elements

Requires patient capacity, disclosure of risks, benefits, and alternatives, comprehension, and voluntary decision. Document the discussion and answer questions before sedation.

Malignant hyperthermia treatment

Stop triggering agents, hyperventilate with 100% oxygen, give dantrolene 2.5 mg/kg intravenously, cool the patient, and treat hyperkalemia and acidosis. Monitor for recrudescence.

Lipid emulsion for LAST

For local anesthetic systemic toxicity, give 20% lipid emulsion 1.5 mL/kg bolus followed by infusion. Avoid vasopressin; secure the airway and control seizures.

Laryngospasm management

Remove the stimulus, apply 100% oxygen with continuous positive airway pressure, and deepen anesthesia. If it persists, give succinylcholine 0.5-1 mg/kg intravenously.

Tension pneumothorax decompression

Needle decompression at the second intercostal space midclavicular line or fifth intercostal space anterior axillary line, followed by tube thoracostomy. Do not delay for imaging.