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WRITTEN EXAMINATION TOPICS LIST The following is a list of topics to prepare for the Written Examination. This list is extensive but in no way exclusive. The information can be found in most textbooks. I. PHYSIOLOGICAL SCIENCES A. PHYSIOLOGY 1. Respiration: Lung Functions and Cellular Processes Lung Mechanics Ventilation – Perfusion Diffusion Blood Gas Transport Regulation of Ventilation Non-Respiratory Functions of Lungs 2. Physiology of the Cardiovascular System Cardiac Cycle Ventricular Function Venous Return Blood Pressure Microcirculation Organ Perfusion Regulation of Circulation and Blood Volume 3. Central and Peripheral Nervous Systems Brain Spinal Cord Cerebrospinal Fluid Neuromuscular and Synaptic transmission Skeletal Muscle Contractions Pain Mechanism and Pathways Autonomic Nervous System 4. Hepatic Function Dual blood supply and its regulation Metabolic and synthetic functions Excretory functions Mechanisms of drug metabolism and excretion Liver function tests 5. Renal Function Blood flow Glomerular filtration Tubular reabsorption and secretion Renal function tests Hormonal regulation of extracellular fluid Hormonal regulation of osmolality Regulation of acid-base balance Drug excretion 1 6. Endocrine Function Pituitary Thyroid and parathyroid Adrenal medulla Adrenal cortex Pancreas 7. Temperature Regulation Temperature sensing - central, peripheral Temperature regulating centers - concept of set point Heat production and conservation Heat loss – mechanisms Body temperature measurements – sites, gradients Special pediatric considerations 8. Aging: Physiological and Pharmacological Implications B. PHARMACOLOGY 1. General Concepts Pharmacokinetics Protein binding Partition coefficients pKa Ionization Tissue uptake Elimination Biotransformation Termination of action 2. Anesthetics: Gases and Vapors Physical properties Mechanism of action Effects on CNS, circulation, respiration, neuromuscular function, renal function, hepatic function, hematologic and immune systems Biotransformation – toxicity Minimal alveolar concentration Trace concentrations O.R. pollution Personnel hazards 3 Anesthetics: Intravenous (Opioid and Non-opioid Induction and Anesthetic Agents) Mechanism of action Pharmacokinetics and pharmacodynamics Metabolism and excretion Effect on circulation Effect on respiration Effect on other organs Adverse effects 4. Anesthetics: Local Mode of action Biotransformation and excretion Comparison of drugs and chemical groups Prolongation of action Toxicity 5. Muscle Relaxants (Depolarizing, Non-depolarizing) Mechanism of action Non-relaxant side effects Abnormal responses Biotransformation and excretion Prolongation of action, termination of action Antagonism Drug interactions, antibiotics, H2 blockers, magnesium 6. Autonomic Drugs Sympathetic Parasympathetic 7. Cardiovascular Drugs Digitalis - actions and toxicity Positive inotropes Antiarrhythmics Antianginal drugs Vasodilators Electrolytes (cardiac effects) Vasoconstrictors 8. Central Nervous System Drugs (Major actions, comparison of drugs; effects on circulation, respiration; adverse effects) Pre- and post- anesthetic medications Antidepressants Antiparkinson drugs Ethyl alcohol Hypnotics - barbiturate and non-barbiturate Anticonvulsants Antieleptics 2 Physostigmine Benzodiazepine antagonists Antiemetics - phenothiazines; butyrophenones; metoclopramide; anticholinergics Antihistamines (H1, H2, Mixed). Drug abuse and addiction, tolerance, dependence. 9. Diuretics Mechanism of action Comparison of drugs Adverse effects Effect on electrolyte and acid-base balance Ultrafiltration 10. Immunosuppressive and anti-Rejection Drugs 11. Drug Interactions Protein binding pH effect Enzyme induction and inhibition 12. Pharmacogenetics Malignant hyperthermia (including diagnosis and therapy) Pseudocholinesterase deficiency 13. Drug Reactions (Anaphylactoid, Anaphylaxis) II. PHYSICAL SCIENCES A. ANATOMY 1. Topographical Anatomy as Landmarks Neck Chest Abdomen Pelvis Extremities 2. Radiological Anatomy Chest Spine 3. Respiratory System Nose Pharynx Larynx Trachea Lungs Muscles of respiration 4. Cardiovascular System Normal anatomy of heart and major vessels Heart conduction system External innervations Coronary circulation Blood supply of other major organs 5. Nervous System Brain Spinal cord and spine Meninges Autonomic nervous system 6. Regional Anesthesia: Main Nerve Blocks Autonomic Head and neck Extremities Trunk Spine B. BIOCHEMISTRY 1. Normal Body Metabolism Carbohydrates Proteins Concerning specific organ metabolism 2. Acid-Base Regulation: Buffer Systems, Effects of Imbalance on Electrolytes and Organ Perfusion 3. Water and Electrolytes: Distribution and Balance, Compartments C. PHYSICS 1. Mechanics Pressure measurements of gases, liquids Transducers, regulators, medical gas cylinders 2. Flow Velocity Viscosity – density Laminar – turbulent Flowmeters Rotameter Electromagnetic Ultrasonic Pneumotachogram 3 3. Properties of Liquids, Gases and Vapors Diffusion of gases Solubility coefficient Relative and absolute humidity Critical temperature, critical pressure 4. Gas Laws 5. Vaporizers Vapor pressure, calculation of anesthetic concentrations Vaporizer types 6. Uptake and Distribution of Inhalation Agents Uptake & elimination curves - effect of ventilation, circulation, anesthetic systems Concentration effect Second gas effect Nitrous Oxide and closed spaces 7. Design of Anesthesia Machines 8. Physics of Breathing Systems Principles Components Characteristics Oxygen supply systems Waste gas evacuation systems Fail safe and other safety features 9. Monitoring Methods Vascular pressures Head function Brain and spinal cord function Neuromuscular function Ventilation Gas concentrations Temperature Oxygen 10. Monitoring Instrumentation Blood gases Gas concentrations Cardiac output Pressure transducers Doppler Oscillometry Blood warmers, cell savers Echocardiography Coagulation monitors 11. Ventilators Classifications Principles of action Nebulizers Humidifiers 12. Alarms Operating room, electrical Anesthesia machine, ventilators, and oxygen 13. Defibrillators Internal, external, implantable; energy, cardioversion; paddle size and position III. CLINICAL SCIENCES A. ANESTHESIA PROCEDURES, METHODS AND TECHNIQUES 1. Evaluation of the Patient and Preoperative Preparation Physical status Pre-medication NPO Recommendation 2. Regional Anesthesia General Spinal Epidural and caudal Peripheral and autonomic nerve blocks IV regional 14. Pacemakers Temporary, permanent, transcutaneous Types - fixed rate, synchronized, ventricular, atrial, 3. General Anesthesia Stages and signs of anesthesia A-V sequential Awareness under anesthesia Standard nomenclature Airway management – intubation, fiberoptic Reasons for failure or malfunction Techniques for difficult intubation 15. Electrical: Fire and Explosion Hazards Endobronchial intubation Source of ignition Complications Prevention 4. Intravenous Fluid Therapy during Anesthesia Macro and micro current hazards Water Safety regulations - NFPA Electrolyte Lasers Glucose requirements and disposition D. MATHEMATICS 5. Concerning Complications (Etiology, Prevention, 1. Simple Math Treatment) Logarithms Trauma Graph of simple equations Chronic environmental exposure Exponential function Mutagenicity Analysis of biologic curves Teratogenicity Carcinogenicity 2. Statistics Scavenging Sample and population, probability Temperature Mean and mode Nausea and vomiting Standard deviation and error Bronchospasm T – test Laryngospasm Chi-square – correlation Analysis of variance 6. Special Techniques Controlled hypotension 3. Computers Controlled hypothermia Data handling Hyperbaric oxygen and anesthesia care Data processing High altitude anesthesia Data analysis Barbiturate coma Anesthesia applications 4 7. Postoperative Period Pain relief Pharmacologic drugs, routes, risks and benefits Respiratory consequences of anesthesia 8. Concerning Anesthesia Record Keeping and Quality Assurance B. DISEASE STATES - CLINICAL PROBLEMS AND THEIR MANAGEMENT 1. Painful Disease States Types of pain Specific pain syndromes Treatment 2. Respiratory System - Classification: Obstructive Disease Upper Airway Tracheobronchial Parenchymal 3. Respiratory System - Classification: Respiratory System Neurologic Musculoskeletal Parenchymal Pleural Mediastinal 4. Management of the Patient with Respiratory Disease Evaluation Anesthetic management Management of respiratory failure 6. Central Nervous System Disorders Seizures Coma Drug intoxication Paraplegia Quadriplegia Spinal shock Autonomic hyperreflexia Depolarizing relaxants Neuromuscular disease Tetanus Special problems of anesthesia for neurosurgery 7. Other Disease Entities Massive obesity Hepatic disease Diabetes mellitus Renal disease Endocrine disorders Intestinal obstruction Hematologic disorders 8. Pediatric Anesthesia Apparatus Premedication Agents and techniques Fluid therapy and blood replacement Physiologic anemia Problems in intubation Neonatal physiology Congenital heart disease Emergencies in the newborn Postoperative analgesia 9. Obstetrical Anesthesia 5. Cardiovascular Disease Maternal Physiology Ischemic heart disease Valvular heart disease 10. Maternal - Fetal Rhythm disorders and conduction defects Pharmacology Heart failure and cardiomyopathy - ischemic, viral, Amniotic fluid (L/S ratio) hypertropic Anesthetic techniques and risks Cardiac tamponade and constrictive pericarditis Physiology of labor Circulatory assist Influence of anesthetic technique on labor Myocardial preservation Fetal monitoring Pulmonary embolism Hypertension 11. Pathophysiology and Complicated Pregnancy Peripheral circulatory failure Problems during pregnancy Vascular disease Problems of term and delivery Cardiopulmonary resuscitation Resuscitation of newborn 5 12. Special Problems in: Endoscopy Microlaryngeal surgery Plastic surgery Gynecology – in-vitro fertilization Urology - lithotripsy Ophthalmology – retrobulbar block, open eye injuries Orthopedics - tourniquet use Trauma Burns Radiology - CT scan, MRI Outpatient anesthesia Electroconvulsive treatment Nutrition and hyperalimentation Anesthetic accidents Risk - benefit of legal medicine Legal medicine Cost of medical care Critical care medicine 6