Anesthesiology BOARD REVIEW Second Edition Kerri M. Robertson, M.D., F.R.C.P. (C) David A. Lubarsky, M.D., M.B.A. Sudharma Ranasinghe, M.D. McGraw-Hill Medical Publishing Division New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Anesthesiology Board Review, Second Edition Copyright © 2006 by The McGraw-Hill Companies, Inc. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a data base or retrieval system, without the prior written permission of the publisher. 1 2 3 4 5 6 7 8 9 0 CUS/CUS 0 9 8 7 6 5 ISBN 0-07-146412-3 Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. The editors were Catherine A. Johnson and Marsha Loeb. The production supervisor was Phil Galea. The cover designer was Handel Low. Von Hoffmann Graphics was printer and binder. This book is printed on acid-free paper. Cataloging-in-Publication data for this title is on file at the Library of Congress. DEDICATION Dr. Jerry Reves To a great man who has dedicated his career to creating a truly academic Department of Anesthesiology at Duke University. Many thanks for your tireless efforts on behalf of the faculty and for your inspiration, guidance and support. KMR and DAL Dedicated to two great departments of anesthesiology at the University of Miami and Duke University Medical Center who made this all possible. Dr. David Lubarsky Dr. Sudharma Ranasinghe Dr. Kerri Robertson SPECIAL THANKS To Chris Keith for his outstanding editorial assistance, patience and humor. To my simply amazing children, Mitchel and Sasha, my unconditional love, always. Kerri Robertson, MD EDITORS Kerri M. Robertson, M.D., F.R.C.P. (C) Associate Clinical Professor Chief of GVTCCM Division Chief Transplant Services Department of Anesthesiology Duke University Medical Center Durham, NC David Alan Lubarsky, M.D., M.B.A. Emanuel M. Pappar Professor and Chair Department of Anesthesiology, Perioperative Medicine, and pain Management University of Miami/Jackson Memorial Hospital Professor Department of Management University of Miami School of Business Miami, FL Sudharma Ranasinghe, M.D. Associate Professor of Clinical Anesthesiology Asst Director of Obstetric Anesthesia University of Miami/Jackson Memorial Hospital Miami, FL CONTRIBUTING AUTHORS Joseph F. Answine, M.D. Staff Anesthesiologist Pinnacle Health System Harrisburg, PA Assistant Professor Department of Anesthesia Penn State Geisinger Health System Hershey, PA Sandralee A. Blosser, M.D. Assistant Professor Surgery, Anesthesia, & Medicine Penn State Geisinger Health System Hershey, PA Christopher A. Bracken, M.D., Ph.D. Associate Professor of Anesthesia The University of Texas Health Science Center San Antonio, TX Richard Brenner, M.D. Department of Anesthesiology UCLA School of Medicine Los Angeles, CA Keith Candiotti, M.D. Assistant Professor of Anesthesiology and Internal Medicine Director for Perioperative Services University of Miami Miami, FL Susan M. Chan, M.D. Assistant Clinical Professor Department of Anesthesiology UCLA School of Medicine Los Angeles, CA Biing-Jaw Chen, M.D. Associate Professor Co-Chief of OB Anesthesia Department of Anesthesiology Harbor-UCLA Medical Center Torrance, CA Jeffrey Chen, M.D. Resident Department of Anesthesia Pennsylvania State University Penn State Geisinger Health System Hershey, PA Susan Chlebowski, M.D. Department of Anesthesiology University of Rochester Rochester, NY Noel Lee Chun, M.D. Assistant Clinical Professor UCLA School of Medicine Los Angeles, CA Gerard DeSouza, M.D. Assistant Professor of Anesthesiology University of Miami School of Medicine V.A. Medical Center Miami, FL Kathleen S. Donahue, D.O. Associate Medical Director Outpatient Surgical Unit Assistant Professor of Anesthesia Penn State Geisinger Health Systems Hershey, PA John B. Eck, M.D. Assistant Professor Department of Anesthesiology Division of Pediatric Anesthesia and Critical Care Medicine Duke University Medical Center Durham, NC Tiberiu Ezri, M.D. Kaplan Hospital Rehovot, Israel James Foster, M.D. Department of Anesthesia Children’s Hospital Buffalo, NY David C. Frankenfield, M.S., R.D. Department of Anesthesia Penn State Geisinger Health System Hershey, PA Keith S. Getz, M.D. Department of Anesthesia Lakewood Medical Center St. Joseph, MI Howard B. Gutstein, M.D. Research Investigator Assistant Professor of Anesthesia The University of Michigan Mental Health Research Institute Ann Arbor, MI Christopher Heard, M.B., Ch.B. Research Assistant Professor Department of Anesthesiology and Division of Pediatric Critical Care Children’s Hospital Buffalo, NY Billy K. Huh, M.D. Associate Department of Anesthesiology Duke University Medical Center Durham, NC Eric Hsu, M.D. Department of Anesthesiology UCLA School of Medicine Los Angeles, CA Judi Hwang, M.D. Department of Anesthesiology UCLA School of Medicine Los Angeles, CA Alma N. Juels, M.D. Assistant Clinical Professor Department of Anesthesiology UCLA School of Medicine Los Angeles, CA Gregory Juarez, M.D. Department of Anesthesiology UCLA Medical Center Los Angeles, CA John Knighton, M.D. Anesthetic Specialist Registrar Salisbury District Hospital NHS Trust Salisbury, Wiltshire United Kingdom Assistant Professor of Anesthesia and Surgery Co-Director of the Surgical Intensive Care Unit Duke University Medical Center Durham, NC Atul Kshatri, M.D. Fellow, Pain Medicine and Palliative Care Clinical Instructor, Anesthesia Penn State College of Medicine Hershey, PA Wing-Fai Kwan, M.D. Associate Professor Chief of OB Anesthesia Department of Anesthesiology Harbor-UCLA Medical Center Torrance, CA David Lindsay, M.D. Clinical Associate Department of Anesthesiology Duke University Medical Center Durham, NC Michael C. Lewis, M.D. Assistant Professor, Anesthesiology University of Miami/Veterans Medical Center Miami, FL Stephen P. Long, M.D. Co-Director Pain Management Center Medical College of Virginia Virginia commonwealth University Richmond, VA Stephen Longo, M.D. Assistant Professor of Anesthesia Director, Obstetrical Anesthesia Penn State College of Medicine The Milton S. Hershey Medical Center Hershey, PA David MacLeod, M.D., FRCA Associate Department of Anesthesiology Duke University Medical Center Durham, NC Mary Mathai, M.D., B.S. Clinical Assistant Professor Department of Anesthesia University of Michigan Ann Arbor, MI John Moore, M.D. Resident Department of Pediatric Anesthesia Cardinal Glennon Children’s Hospital St. Louis University St. Louis, MO Eugene W. Moretti, M.D. Associate Department of Anesthesiology Duke University Medical Center Durham, NC Gundappa Neelekanta, M.D. Department of Anesthesiology UCLA School of Medicine Los Angeles, CA Kirsten O’Neil, M.D. Resident in Anesthesiology University of Miami Miami, FL Gurpreet Singh Padda, M.D. Assistant Professor Department of Pediatric Anesthesia Cardinal Glennon Children’s Hospital St. Louis University St. Louis, MO Lynnus Peng, M.D. Fellow Department of Anesthesia and Critical Care Medicine Johns Hopkins Hospital Baltimore, MD Scott D. Picker, M.D. Assistant Clinical Professor of Anesthesia UCLA Medical Center Los Angeles, CA Michael R. Pinsky, M.D. Professor of Anesthesiology, Critical Care Medicine and Medicine University of Pittsburgh Medical Center Oakland V.A. Medical Center Pittsburgh, PA Marcus Q. Polk, M.D. Anesthesiology Resident Emory University School of Medicine Atlanta, GA Juan Carlos Restrepo, M.D. Diplomat of the American Board of Anesthesiology V.A Medical Center Jackson Memorial Hospital University of Miami Miami, FL G. Chase Robinson, Jr., M.D. Assistant Professor Department of Anesthesiology The University of Texas Health Science Center at San Antonio San Antonio, TX Garfield B. Russell, M.D. Acting Chair Department of anesthesia Penn State Geisinger Health System Hershey, PA John Robert Schultz, M.D. Associate Department of Anesthesiology Division of Women’s Anesthesia Duke University Medical Center Durham, NC Allan B. Shang, M.D. Assistant Clinical Professor Department of Anesthesiology Division Chief of Offsite Anesthesia Services Duke University Medical Center Durham, NC Jay R. Shayevitz, M.D., M.S. Providence Hospital and Medical Centers Southfield, MI Jacques Somma, M.D., FRCP (C) Director of the Human Pharmacology Laboratory Assistant Professor Department of Anesthesiology Duke University Medical Center Durham, NC Timothy Stanley, M.D. Associate Department of Anesthesiology Duke University Medical Center Durham, NC R. H. Steadman, M.D. Department of Anesthesiology UCLA School of Medicine Los Angeles, CA Yung-Fong Sung, M.D. Professor of Anesthesiology Emory University School of Medicine Chief of Anesthesiology Ambulatory Surgery Center The Emory Clinic Atlanta, GA Kenneth M. Sutin, M.D. Assistant Professor of Clinical Anesthesia and Clinical Surgery New York University Director of Recovery Room and Associate Director of Critical Care Bellevue Hospital New York, NY Peter Szmuk, M.D. Kaplan Hospital Rehovot, Israel James F. Szocik, M.D. Clinical Assistant Professor Department of Anesthesiology University of Michigan Medical Center Ann Arbor, MI John Thomas, M.D. Department of Anesthesiology UCLA School of Medicine Los Angeles, CA Barbara Vineis, R.N., M.P.H., J.D. Department of Anesthesiology UCLA School of Medicine Los Angeles, CA Ian James Welsby, M.D., BSc, MBBS, FRCA Associate Department of Anesthesiology Duke University Medical Center Durham, NC Daniel P. Williams, D.O. Clinical Instructor of Anesthesia Penn State Geisinger Health System Hershey, PA David Wright, M.D., FRCA Associate Department of Anesthesiology Duke University Medical Center Durham, NC Elaine Yang, M.D. Associate Professor Department of Anesthesiology Harbor-UCLA Medical Center Torrance, CA Ahmed Zaki, M.D. The University of Michigan Mental Health Research Institute Ann Arbor, MI INTRODUCTION 1 and 3. 2 and 4. 1, 2, and 3. 4 alone. If 1 is true, then 3 is true and vice-a-versa. If 2 is true, so is at least one other choice. We have it on good authority that the Marquis de Sade used “K-type” questions on those he wished to torture most. His minions, in the guise of academic test creators, have persevered over the centuries to make sure this unique form of torture is widely inflicted. We hear that the ABA is considering abandoning these types of questions in the near future. To that we say, “Good riddance!” In a book like ours, it is the answers, not the format of the questions, that make the book, so, no matter what the ABA does, the simple question answer format here will serve you well until the third edition comes along (which of course you must buy!). How many false answers will you read practicing “K-type” questions? 50%. How many false answers will you consider in the “one best answer” question type? 75%. We remember what we read. So, right before the exam, after you’ve practiced test-taking, and conquered the strategy for “K-type” questions, it’s time to focus on correct answers. That way, what’s freshest in your memory as you sit for the boards will always be a correct potential answer. Hence….Pearls of Wisdom. One in a series of written board review texts created for many medical specialties, this format has proven itself as the best preparation immediately before the exam. Hundreds of questions garnered from across the nation and from multiple institutions. Questions that have only the correct answer. Read it, remember it, and score well! As anyone will tell you, reviewing board review books doesn’t make you smart, and just knowing the answers in this book does NOT guarantee a good board exam score. If you read something, and do not understand the answer, or are not sure about a related topic that pops into your mind, LOOK IT UP! Neither this tome (nor its three humble authors) are substitutes for Barash, Stoelting, and Miller. Our book is a quick pre-boards review and was edited for that purpose; their textbooks are for the acquisition of knowledge. So use their books when you need a more complete understanding. If you would like to contribute questions for the next edition, just e-mail them to us at