Dr. Jensen Anesthesiology Board P.R.E.P., 235 Lexington Avenue, Iowa City, IA (2025)

07/31/2023

Question Monday from Dr. Jensen Online Question Bank!

single best
Modified Old Board and/or Keyword Remembered Question
The most important factor regulating blood flow in ischemic cerebral tissue is
A) systolic blood pressure
B) PaO2
C) cerebral perfusion pressure
D) PaCO2
E) cerebral oxygen consumption

Answer: See Below!

Most important factor regulating blood flow in ischemic cerebral tissue

1. Cerebral perfusion pressure is the most important single factor in the regulation of blood flow to ischemic cerebral tissue. Strong consideration was given to carbon dioxide because of its local vasodilating properties. A neuroanesthesiologist, neurosurgeon, and 85% Ranger hitter were consulted. After much discussion, cerebral perfusion pressure was selected as the best single choice because of disturbance of local autoregulation during ischemia and the importance during this time of pressure to blood flow. Flow to these ischemia areas becomes pressure dependent.

2. Vessels in ischemic areas are already maximally vasodilated to compensate for ischemia. They have largely lost their responsiveness to carbon dioxide.

Answer: C) cerebral perfusion pressure

Like, share, and follow us!
New Question every Monday!
Connect with us!
https://www.anesthesiologyboards.com/
email: njensen@boardprep.com
Phone: 319-337-3700

07/26/2023

Passed Your Exam and Studying for Oral Boards?

Congratulations!

The Oral Board program combines the best homestudy materials with the top course for Oral Boards. Big Red and Spiels are the premier homestudy tools for verbal organization. Ranger Red Cases and Audio MP3's put scripting, practice, and outlining together to turn it into a "talking test"--exactly what it is. The course is the toughest and the best. No one has coached Oral Board Prep as much or as well as Dr. Jensen.

Failing the Oral exam is usually due to incomplete knowledge, poor organization, or inadequate presentation of essential material. Listening to lectures in a review course provides some useful review of information but does not help you organize and verbalize essential information. Success can be found in a combination of well-honed knowledge, excellent organization and effective practice--exactly what the program delivers.

https://www.anesthesiologyboards.com/ordering/

07/24/2023

Question Monday from Dr. Jensen Online Question Bank!

Single best
Modified Old Board and/or Keyword Remembered Question
Type I diabetes is associated with all of the following EXCEPT:
a) Delayed healing
b) Decreased phagocytic production and function
c) Decreased neural function
d) Increased prevalence of thromboembolism
e) none of the above

Answer: See Below!
Diabetes

1. All statements except the final one related to increased prevalence of thromboembolism can be documented.
a. Delayed healing is certainly an effect of diabetes, secondary primarily to atherosclerosis and small vessel disease.
b. Decreased phagocytic function is an effect of diabetes. Miller states, "Major risk factors for diabetics undergoing surgery are end-organ diseases . . . CV dysfunction, renal insufficiency, joint and collagen tissue abnormalities, poor wound healing, inadequate granulocyte production, and neuropathies. . . Many alterations in leukocyte function have been demonstrated in hyperglycemic diabetics."
c. Decreased neural function is an effect of diabetes. Miller states, "Diabetes is the most common cause of autonomic neuropathy."
d. Diabetes is associated with conditions (like obesity) which themselves lead to increased prevalence of thromboembolism but, again, increased prevalence of thromboembolism with diabetes alone cannot be documented. Also, the case for choice 4 would be easier and better if type II diabetes (more often associated with obesity) was present, rather than type I diabetes.

2. There is a viable “except” in the answer choices, which is being queried, and that “except” is choice D., namely that type I diabetes is not generally associated with an increased prevalence of thrombophlebitis.

Answer: D.Like, share, and follow us!

New Question every Monday!
Connect with us!
https://www.anesthesiologyboards.com/
email: njensen@boardprep.com
Phone: 319-337-3700 Increased prevalence of thromboembolism

07/17/2023

Question Monday from Dr. Jensen Online Question Bank!

Modified Old Board and/or Keyword Remembered Question
The short duration of alfentanil is due to:
a) Very high lipid solubility
b) High volume of distribution
c) Extensive hepatic metabolism
d) Minimal protein binding
e) None of the above

Answer: See Below!
Alfentanil: Short duration of action

1. Alfentanil (10-50 ug/kg) has a rapid onset (due to low pKa) and short duration of action (due to low volume of distribution and extensive hepatic metabolism). It has lower lipid solubility and greater protein binding than morphine. Therefore, choice A. is false. Choice B. is false. Choice D. is false, and choice C. is true as alfentanil is subject to extensive hepatic metabolism..

2. Onset of action is 1-2 minutes versus 5-6 minutes for fentanyl. As noted, this rapid onset is due to low pKa such that 90% of the drug exists in the nonionized form. The nonionized form crosses the BBB more quickly.

3. Short duration is due to low volume of distribution plus hepatic metabolism, which is extensive (leading to the production of inactive metabolites). In patients with cirrhosis of the liver, the elimination half life is 200 minutes.

4. Unlike thiopental or fentanyl, repeated doses do not result in significant cumulative effect.

5. The volume of distribution is 4x's smaller than fentanyl because of lower lipid solubility and greater protein binding.

Answer: C. Extensive hepatic metabolism

Like, share, and follow us!
New Question every Monday!
Connect with us!
https://www.anesthesiologyboards.com/
email: njensen@boardprep.com
Phone: 319-337-3700

07/13/2023

Putting in the hours studying for the Written Boards?

Combine the #1 home study materials with the #1 course and you have a powerful combination for success on Written Boards. Big Blue, Baby Blue, Ranger Blue, and online testing are the premier tools to focus upon Written Board content. The "question and answer" course is the most efficient manner to review relevant information and assess strengths and weaknesses. The program is critically and fundamentally different from others in that it provides the integration and focus you need to win. Too often, valuable preparation time is spent in an unfocused manner. The mission of this program is to relentlessly focus upon the very information most likely to be tested.

https://www.anesthesiologyboards.com/ordering/

08/01/2022

Question Monday from Dr. Jensen Online Question Bank!

Single best answer
A 64-year-old, 90-kg woman, who had hepatitis at age 22 and has a long history of asthma for which she takes prednisone, is undergoing cholecystectomy with fentanyl-nitrous oxide-oxygen anesthesia supplemented by rocuronium. Thirty minutes after induction the surgeon states that exposure is becoming more difficult and moderately intense wheezing is apparent. Blood pressure is increased from 110/60 to 150/90 torr, and heart rate is 130/min. Your first response should be to:

A. obtain arterial blood gas analysis
B. administer pancuronium, 10 mg
C. administer isoflurane
D. administer propranolol
E. administer epinephrine, 50 µg intravenously1.

Answer: See Below!

A. obtain arterial blood gas analysis
B. administer pancuronium, 10 mg
C. administer isoflurane
D. administer propranolol
E. administer epinephrine, 50 µg intravenously1.

Answer: C. administer isoflurane

Like, share, and follow us!
New Question every Monday!
Connect with us!
https://www.anesthesiologyboards.com/
email: njensen@boardprep.com
Phone: 319-337-3700

07/25/2022

Question Monday from Dr. Jensen Online Question Bank!

Which of the following serum laboratory tests is indicated for confirmation of the diagnosis of anaphylaxis?

A. C1 esterase
B. Tryptase
C. Complement
D. Histamine
E. Anti-cardiolipin

Answer: See Below

Diagnosis of anaphylaxis

1. “Anaphylaxis is a severe immune-mediated reaction that affects the cardiovascular, pulmonary, cutaneous, and gastrointestinal systems. Anaphylaxis and anaphylactoid reactions are identical in clinical presentation and treatment. A suspicion of anaphylaxis requires evaluation to determine the cause and confirm the diagnosis.”

2. “Tryptase is a serine protease released mainly from secretory granules in mast cells. When attempting to confirm anaphylaxis, it is best to draw a tryptase level within one to three hours and within five to six hours from the onset of symptoms. A normal tryptase level is typically below 11 mg/mL. Although elevated tryptase levels likely confirm anaphylaxis, normal levels do not rule out anaphylaxis, especially if blood sample acquisition was delayed. To specifically diagnose anaphylaxis, an elevated tryptase level followed by a normal repeat tryptase level 24 hours later is needed. If both early and delayed tryptase levels are elevated, a diagnosis of mastocytosis (mast cell disorder) should be considered.”

3. “A low C1 esterase is useful to diagnose hereditary angioedema which typically causes angioedema of the upper airway tract. Complement levels are typically low after anaphylaxis. Histamine levels peak within 10 minutes and resolve within 60 minutes in anaphylaxis cases. Neither C1 esterase, complement, nor histamine levels is specific enough to rule in anaphylaxis.”

4. “Tryptase levels can be used to confirm a diagnosis of anaphylaxis.” Therefore, the best answer is C.

Answer: C. Complement

Like, share, and follow us!
New Question every Monday!
Connect with us!
https://www.anesthesiologyboards.com/
email: njensen@boardprep.com
Phone: 319-337-3700

07/21/2022

Are you struggling to study? Our Written and Oral Board home-study books bring under one roof everything you need to pass. Focused study is the key!

It would be an honor to work with you. I send along my best wishes and regards.

My email is njensen@boardprep.com, my office 1-800-321-7737. Write or call with any questions or concerns and at any time.

https://www.anesthesiologyboards.com/ordering/

07/18/2022

Question Monday from Dr. Jensen Online Question Bank!

A 35 year old female sustained burns to her face. She has metabolic acidosis. What is the most likely reason?
A. Hypovolemia
B. Decreased cardiac output
C. Carbon monoxide poisoning
D. ARDS
E. none, metabolic acidosis inconsistent with clinical scenario

Answer: See Below!

35 year old female with burns to her face, now with metabolic acidosis. Cause?

1. Points which stick out here are the metabolic acidosis which is now apparently present and the fact that the burn is noted to specifically involve the face--raising the prospect of inhalational involvement and injury. Be careful. . . Board examiners shoot down knee-jerkers first, so don’t jump to round up the usual suspects of hypovolemia and carbon monoxide poisoning.

2. The fact that this involves the face limits the degree of hypovolemia, even though it would still be significant. Would it be significant enough to cause academia? Tough call, it’s not unreasonable and in fact could be argued for. The question is weather another “single best” exists.

3. Let’s review smoke inhalation and with special attention to the issue of metabolic acidosis, a linkage which is certainly not upper most in our minds. This analysis shows, in fact, it should be and that metabolic acidosis goes hand in hand with asphyxiation. . .

Haddad and Winchester's Clinical Mgt of Poisoning and Drug Overdose

At a Glance…
▪ Smoke inhalation accounts for more than 80% of fire-related fatalities, most of which result from residential fires.

▪ The pathophysiology of smoke inhalation is multifactorial and involves additive or synergistic toxicity from hypoxia, thermal injury, and numerous chemical toxins (e.g., carbon monoxide, hydrogen cyanide, irritant gases).

▪ The ultimate cause of death in patients with smoke inhalation is asphyxia (i.e., tissue hypoxia and consequentacidosis).

▪ Thecarboxyhemoglobinfraction is elevated in virtually all patients exhibiting signs and symptoms of asphyxia.

▪ Unexplained coma, severe metabolic (lactic)acidosis, and refractory hypotension victims suggests cyanide poisoning.

▪ Urgent endotracheal intubation is indicated in patients with cyanosis or hypoxemia despite oxygen therapy, respiratory depression or acute hypercarbia, pulmonary edema, altered mental states, full-thickness burns of the face or neck, and respiratory distress due to upper airway obstruction.

▪ Intubation should also be considered for patients with upper airway pathology on laryngoscopy or a respiratory rate of more than 30 breaths/min who do not improve with oxygen or other pharmacologic therapy.

▪ Hyperbaric oxygen can be effective in treating carbon monoxide or cyanide poisoning, cerebral edema, and thermal burns; it should also be considered for patients with refractory hypoxemia.

▪ When cyanide poisoning is suspected in smoke inhalation victims, sodium thiosulfate may be administered without nitrates.

Answer: C. Carbon monoxide poisoning

Like, share, and follow us!
New Question every Monday!
Connect with us!
https://www.anesthesiologyboards.com/
email: njensen@boardprep.com
Phone: 319-337-3700

07/14/2022

Struggling to study or pass?

We train the best to be their best, and our track record is strong: we’ve helped over 30,000 anesthesiologists become Board certified over the past 30 years with premier home-study materials, live and virtual courses, sound, and question banks. We specialize in helping anesthesiologists who struggle with standardized tests, usually for a variety of reasons. If you have failed, or are at risk of failing, call us ASAP. We can help!

We’d love to work with you, so please consider our transformative books and sound, our online testing center which has the highest quality questions and answers, our Zoom meetings, and our live course dates at www.boardprep.com.

My email is njensen@boardprep.com, my office 1-800-321-7737. Contact me at any time.

https://www.anesthesiologyboards.com/ordering/

07/11/2022

Question Monday from Dr. Jensen Online Question Bank!

Which of the following is typically associated with photosensitivity:

A. Garlic
B. Ginseng
C. Gingko
D. St. Johns wort
E. none of the above

Answer: See Below!

Nutraceuticals: photosensitivity
1. Remember, when it comes to neutraceuticals, “The G’s cause C’s,” namely coagulopathies.

2. Let’s look at the players:

Garlic
a. Garlic has been used for centuries for a variety of ailments. Recent studies have centered upon purported vasodilator and hypocholesterolemic activity. A British study suggests garlic may lower total cholesterol by 12%, while other studies are nonconfirmatory. Less solid evidence exists for antihypertensive effects. An important side effect appears to be decreased platelet aggregation. Garlic may augment the effects of warfarin, heparin, nonsteroidal anti-inflammatory agents, and aspirin. One reported case links garlic to spontaneous spinal/epidural hematoma.

Ginseng
a. The active compound in ginseng is ginsenoside. It has been used for anti-aging, energy boosting, and as an aphrodisiac. Ginseng has also been shown to have a hypoglycemic effect and should be avoided in in patients on insulin or oral hypoglycemics. Like garlic, ginger, and ginko ginseng should be avoided in patients on coumadin, heparin, NSAIDs, and aspirin or those requiring neuraxial blockade. Ginseng also causes hypertension. Ginseng should not be used with MAOIs as manic episodes have resulted from this combination.

Ginko biloba
a. Ginko has been used for medicinal purposes since 3000 B.C. It is one of the best-selling herbs in the United States, with annual revenue exceeding $250 million. It is used for a variety of purposes including intermittent claudication, tinnitus, memory loss, and impotence. Ginko is considered relatively safe but has been associated with bleeding abnormalities, including spontaneous hyphema (bleeding from the iris into the anterior chamber), subarachnoid hemmorhage, and spontaneous subdural hematoma. Like garlic and ginger, ginko should be avoided in patients on coumadin, heparin, NSAIDs, and aspirin or those requiring neuraxial blockade. Ginko should also probably be avoided with the concomitant use of anticonvulsives and TCAs, as it seems to decrease the effectiveness of these agents by an unknown mechanism.

St. John’s Wort
a. St. John’s Wort is most commonly used for anxiety, depression, and sleep disorders. It is one of the most popular drugs in Germany, with several million regular users. Its mechanism of action is likely to be GABA or serotonin receptor inhibition. Photosensitivity is the most common side effect and photosensitive drugs such as tetracycline and piroxicam should not but used concomitantly.

Answer: D. (St. Johns wort)

Like, share, and follow us!
New Question every Monday!

Connect with us!
https://www.anesthesiologyboards.com/
email: njensen@boardprep.com
Phone: 319-337-3700

07/07/2022

Niels F. Jensen, M.D., is the #1 Board Coach in the United States. He has coached more anesthesiologists through boards than anyone. One-third of all board-certified anesthesiologists have worked with Dr. Jensen to achieve certification. No one has focused on the requirements of anesthesiology Board certifications and no one is in a better position to help you beat the beast of Boards.

Order today! https://www.anesthesiologyboards.com/ordering/

If you have already passed Boards, please like and share this with a friend or colleague. Your recommendation would mean a lot! Thank you for your consideration!

Dr. Jensen Anesthesiology Board P.R.E.P.

07/31/2023

07/26/2023

07/24/2023

07/17/2023

07/13/2023

08/01/2022

07/25/2022

07/21/2022

07/18/2022

07/14/2022

07/11/2022

07/07/2022

Address

Telephone

Website

Alerts

Shortcuts

Share

Category