ITE Cram Sheets

Written By Kenny John

The ITE (or In-Training Exam) is an annual exam for Anesthesiology trainees that tests their clinical knowledge. Residency programs typically use it as a benchmark for likelihood of passing the BASIC and ADVANCED Board Exams. These two sheets are designed to be high-yield cram sheets of factoids that I felt like were commonly tested and easy to memorize for the test.


EQUATIAONS

  • Vaporizer Output = Common Gas Flow (CGF) x SVP/(BP - SVP)

    • SVP = saturated vapor pressure

    • BP = barometric pressure

    • Sevo SVP = 160 mmHg

    • Iso SVP = 240 mmHg

    • Des SVP = 669 mmHg

  • % delivered (dial @ 1 %) = SVP wrong agent/SVP wrong vaporizer

  • % delivered @ high altitude = 760 mmHg/BP @ high altitude

  • Airway Resistance = P(peak) - P(plat)/Flow rate

    • P(peak) = peak pressure

    • P(plat) = plateau pressure

  • Maximum Allowable Blood Loss (MABL) = EBV x (start HCT - target HCT)/start HCT

    • EBV = estimated blood volume

    • Hct = Hematocrit

  • Standard Error of Mean = standard deviation/√n

    • n = number of participants in study

  • Sensitivity = TP/(TP + FN)

    • TP = true positive

    • FN = false negative

    • Screen Tests

  • Specificity = TN/(TN+FP)

    • TN = true negative

    • FP = false positive

    • Diagnostic Tests

  • PPV = TP/(TP+FP)

    • PPV = positive predictive value

  • NPV = TN/(TN+FN)

    • NPV = negative predictive value


Volatiles

Sevoflurane

  • SVP = 160 mmHg

  • Blood:Gas coefficient = 0.65

  • MAC = 2.2

Isoflurane

  • SVP = 240 mmHg

  • Blood:Gas coefficient = 1.46

  • MAC = 1.1

Desflurane

  • SVP = 669 mmHg

  • Blood:Gas 0.42

  • MAC 6.6


Estimated Blood Volumes

Premature 100 ml/kg

Full term 90 ml/kg

Infant 80 ml/kg

Child 75 ml/kg

Male Adult 70 ml/kg

Female Adult 65 ml/kg


Types of Error

Type 1 Error = False Positive

  • P value 0.05 = 5% chance of type 1 error

Type 2 Error = False negative


Flow Meters

Lower Part —> Laminar Flow —> Affected by viscosity

Upper Part —> Turbulent Flow —> Affected by density


Ultrasound

High Frequency Waves

  • short wavelength

  • higher image resolution

  • limited depth of penetration

Low Frequency Waves

  • large wavelength

  • low image resolution

  • deeper depth of penetration

Color Doppler (“BART”)

  • Blue = Away from transducer

  • Red = Towards the transduce


Sympathetic Blocks for Cancer Pain

Stellate Ganglion Block

  • Head, neck, upper extremity block

  • Side effects: Horner’s syndrome, increase temperature in upper extremities

Celiac Plexus Block

  • Upper abdomen, pancreatic block

  • Side effects: diarrhea, orthostatic hypotension

Superior Hypogastric Block

  • Pelvic organ block

Lumbar Plexus Block

  • Low limb block


Airway Nerves

Nasopharynx, Soft/Hard Palate

  • CN V (maxillary branch)

Anterior 2/3 of Tongue

  • CN V (mandibular branch)

Posterior 1/3 of Tongue, Pharynx, Superior Epiglottis

  • Glossopharyngeal nerve

  • Blocked by tonsillar fossa injection

Inferior Epiglottis, Larynx up to Vocal Cords

  • Superior Laryngeal nerve

  • Blocked by greater cornu of hyoid bone injection

Larynx Inferior to Vocal Cords

  • Recurrent Laryngeal nerve

  • Blocked by transtracheal injectino


Orthopedic Injuries Leading to Damaged Nerves

Proximal Humerus Fracture

  • Axillary nerve injury

Mid-Shaft Humerus Fracture

  • Radial nerve injury

Posterior to Medial Epicondyle (“funny bone”)

  • Ulnar nerve injury

Anterior Cubital Fossa

  • Median nerve injury


Spinal Cord Anatomy

Adult Anatomy

  • Cord ends at L1

  • Dural Sac ends at S1-2

Neonatal Anatomy

  • Cord ends at L3

  • Dural Sac ends at S3-4


NIOSH (National Institute of Occupational Safety and Health) Limits

  • N20 alone = 25 ppm

  • Iso/Sevo/Des alone = 2 ppm

  • Iso/Sevo/Des + N2O = 0.5 ppm


Dibucaine Number (Pseudocholinesterase Deficiency Test)

Normal = 80

  • length of paralysis with succinylcholine = 20 min

Heterozygous Trait = 40-60

  • length of paralysis = 1-2 hours

Homozygous Trait =20

  • length of paralysis = > 4 hours


Local Anesthetics

Properties

  • onset = pKA, drug concentration

  • duration = protein binding

  • potency = lipid solubility

LA Allergens

  • Ester = PABA

  • Amides = methylparaben

LAST Risk

  1. Intercostal

  2. Caudal

  3. Epidural

  4. Brachial Plexus

  5. Femoral Sciatic


Drugs to Avoid

Alzheimer’s Disease - avoid anticholinergic drugs

Parkinson’s Disease - avoid antidopaminergic drugs


Organophosphate Poisoning

Prophylaxis = pyridostigmine

Treatment = atropine, pralidoxmine


Diuretic Metabolic Derangement

Loop Diuretics/Thiazides

  • metabolic alkalosis (hypokalemia)

Amiloride/Spironolactone

  • metabolic acidosis (hyperkalemia)

Acetazolamide

  • metabolic acidosis

  • decreased K+, decreased Na+, increased Cl-


IV Fluids

Lactated Ringers

  • pH = 6.5

  • osmolality = 273

  • Na = 130

  • Cl = 109

  • K = 4

  • Ca = 1.5

  • Lactate = 28

Normal Saline (NaCl 0.9%)

  • pH = 5.5

  • osmolality = 286

  • Na = 154

  • Cl = 154


Antiplatelet Drugs

ADP Antagonists

  • Ticlodipine

  • Clopidogrel

  • Prasugrel

COX Inhibitors

  • Aspirin

PDE Inhibitors

  • Dipyridamole

GP IIb/IIIa Inhibitors

  • Tirofiban

  • Eptifibatide

  • Abciximab


Oral Anticoagulation Reversal

Warfarin —> PCC

Rivaroxaban/Apixaban —> Recombinant Factor X (Andexxa)

Dabigatran —> Idarucizumab


Specialized Packed RBCs

Irradiated pRBCs

  • Good for immunodeficient patients

  • Reduces Grafts vs Host reaction

Leukocyte Reduced

  • Decreases febrile reactions and transmission of CMV/EBV


Obstructive Sleep Apnea Severity

Acute Hypoxic Index (AHI) Scores

  • Normal = < 5

  • Mild = 5-15

  • Moderate 15-30

  • Severe > 30


Carbon Dioxide Physics Principles

Haldane Effect

  • deoxygenated hemoglobin has increased CO2 carrying capacity (venous blood)

Bohr Effects

  • effect of PaCO2 on hemoglobin-oxygen dissociation curve (rightward shift)


Ventilation Chemoreceptors

Central

  • medulla oblongata

  • responds to changes in H+ in CSF

Peripheral

  • carotid/aortic bodies

  • responds to changed in PaO2 and PaCO2


Baroreceptors

Carotid sinus/aortic baroceptor —> glossopharyngeal nerve (CN IX) —> medulla —> vagus nerve (CN X) —> heart rate change


Lung Capacity Changes

Elderly

  • FRC = normal or increased

  • Closing Capacity = increased

  • Dead space = increased

Obese

  • FRC = decreased

  • CC = normal

  • Dead space = normal

Pregnancy

  • FRC = decreased

  • CC = normal

  • Dead space = normal

Neonates

  • FRC = decreased

  • CC = normal

  • Dead space = normal


Coronary Circulation

Right Coronary Artery (RCA)

  • supplies inferior wall

  • EKG changes on II, III, aVF

  • can lead to AV block

Left Circumflex Artery (LCX)

  • supplies lateral wall

  • EKG changes on I, aVL

Left Anterior Descending (LAD)

  • supplies anteroseptal wall

  • EKG changes on V3-V6


MRI Scanner Zones

Public Area = Zone 1

Holding Area = Zone 2

Control Room = Zone 3

Scanner = Zone 4


Cirrhosis Severity Scores

Child-Pugh Score

  • “Pour Another Beer After Eleven”

  • PT/INR

  • Albumin

  • Bilirubin

  • Ascites

  • Encephalopathy

MELD Score

  • “I Crush Several Beers Daily”

  • INR

  • Creatinine

  • Sodium

  • Bilirubin

  • Dialysis



Kenny John
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