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Prodigy > 2 > Flashcards

2 Flashcards

1
Q

which blood product contains all coagulation factors?

A

FFP

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2
Q

the leading cause of death r/t blood transfusion is?

A

transfusion associated circulatory overload

more likely to happen to pt that are critically ill

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3
Q

what are disadvantages to storing blood?

A

-progressive decrease in ATP and 2,3 dpg
-results in L shift
-even though admin of hgb will increase ability of blood to transport oxygen, the longer the blood is stored and the more of it that is given, the ore the pt oxyhgb diissociation curve shifts L -> decreasing effectiveness of the blood given
-K in stored blood increases- can be hazardous when lg doses of blood is admin

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4
Q

the recmmended therapeutic dose of plt concentrate is 1 plt concentrate per

A

10 kg of body mass

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5
Q

in what pt would be admin of uncrossmatched type o, rh pos blood be contraindicated

A

uncrossed type o rh pos blood can be adminisered to males or females who are not childbearing age who have never recieved o pos blood before.

if the pt is female child bearing age or if pt blood admin hx is unknown- then you should use o neg blood

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6
Q

when are plt transfusions indicated? when plt count drops below

A

50,000

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7
Q

what does cryo contain

A

factor VIII, von williebrand, fibrinecton, and fibrinogen

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8
Q

what is the recommended dose of FFP to reverse the effects of warfarn?

A

5-8 mL/kg

for all other purposes the dose should be 10-20 mL/kg

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9
Q

what is acute normovolemic hemodilution?

A

alternative to transfuison. whole blood is removed from the pt prior to surgery with replacement of lost volume in the form of crystalloids or colloids. by diluting vascular bed, any blood lost during surgery will have a lower hct. the previous removed blood is then reinfused back into the patient when intraop blood loss has ceased.

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10
Q

allergic rxns to blood transfusions are mediated by what antibodies

A

igE and donor plasma proteins

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11
Q

a pt with von williebrand disease is experiencing cont bleeding at the site of his surgical incision despite tx with DDAVP. the next treatment you would recommend for this patient is

A

cryo. this pt should get desmopressin which increases factor VIII- vWF complex and improves coagulation. if desmopressin doesnt work then cryo should be considered

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12
Q

how much should the hgb increase by 1 unit

A

1 unit should increase hgb by 1 and hct 2-3

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13
Q

a fully soaked laparotomy sponge will hold about __ mL of blood

A

100-140 mL of blood

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14
Q

common reasons to give cryo

A

-von williebrand
-pt with low fibrinogen levels (<80)

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15
Q

what issue would you expect to result from a catastrophic failure of the oxygen first stage regulator?

A

significant loss of oxygen pressure regardless if it was from the oxygen cylinder or the pipeline

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16
Q

when carbon dioxide absorbent is exhausted, what chemical accumulates in the cannister?

A

carbonic acid accumulates, turning the indicator dye purple

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17
Q

where are bacterial filters on the machine?

A

at the y piece- serving as both inspiratory and expiratory filters

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18
Q

which diuretics enhance the reabsorption of calcium in the distal tubule and can potentially result in hypercalcemia?

A

thiazide type diuretics- enhance reabsorption of ca in distal tubule

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19
Q

what device monitors the integrity of the isolated power supply for an operating room?

A

line isolation monitor

operating rooms often have an isolated power supply- decrease the incidence of inadvertant electrical shock if a pt or healthcare worker come into contact with a single live wire. unless both power lines are contacted, a circuit is not completed, and the risk for electrical shock is minimized. the presence of a faulty piece of equipment can turn an isolated power supply into a traditional, grounded electrical source, and electrical shock becomes a higher risk.

a line isolation monitor constantly evaluated the integrity of the system to produce an alert if this happens

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20
Q

a drug with a high hepatic extraction ratio exhibits a decreased metabolism in elderly patients primarily due to a decrease in

A

hepatic blood flow

hepatic transaminase levels and hepatic enzyme activity do not normally change with increased age.

hepatic mass does decrease with age, but clearance of drugs with high hepatic extraction ratio relies on hepatic blood flow not hepatic mass

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21
Q

patients with chronic renal failure tend to exhibit
A. hypokalemia
B. hyperventilation
C. hypophosphatemia
D. hypercalcemia

A

B. hyperventilation

due to chronic metabolic acidosis and increased predisopsition to pulm edema

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22
Q

if not accompanied with an anticholinergic, the admin of neostigmine can produce
A. paralytic ileus
B. tachycardia
C. salivation
D. bronchodilation

A

C. salivation

profound PNS effects (bronchospasm, salivation, increased bowel mobility)

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23
Q

vapor pressure of des is __ x that of other contemporary inhaled anesthetics

A

3-4 x

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24
Q

what does des boil at

A

22.8 c (slightly above rm temp)

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25
Q

what hemodynamic parameter decreases during laprascopic abdominal surgery?
A. stroke volume
B. SVR
C. HR
D. MAP

A

A. stroke volume

map, svr and hr typically all incease

svr decreases

cvp and co may increase or decrease

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26
Q

what is true about the vaporizing pumping effect?

A

-can result in elevated vaporizer output
-more prominent at high resp rates
-more prominent with low flows, low vaporizer dial settings, low levels of anesthetic in vaporizer chambers

it is an intermittent back pressure caused by pos pressure ventilation of use of oxygen flush valve

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27
Q

advanced directives for pt undergoing anesthesia are typically

A

suspended and resumed after postop period

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28
Q

where does aldosterone work in the nephron

A

late, distal convoluted tubule
corticol portion of collecting tubule

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29
Q

activation of plasminogen to plasmin is a major step in

A

fibrinolysis

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30
Q

what substance is primarily responsible for activating plasminogen

A

tPA

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31
Q

what is the normal PR interval

A

120-200 milliseconds

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32
Q

what do you expect to see with addisons?

A

weakness, anorexia, n, v, hyperpigmentation, chronic hypotension, hypovolemia, hyponatremia, hyperkalemia

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33
Q

protein binding of drugs is lowest among
A. term infants
B. children between 1-3 yrs old
C. adolescents
D. adults

A

A. term infants

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34
Q

spinal shock is consistent with which of the following?
A. warm, pink extremities
B. exaggerated hyperK response to sux within 3 hrs of injury
C. shock symptoms typically resolve within 6 hrs
D. HTN

A

A. warm, pink extremities

it disrupts commpensatroy vasoconstricve response

hemorrhagic shock: cool clammy extrem
spinal shock: warm, pink extrem

some ppl will use sux during first 24 hrs b/c upregulation of extrajunctional receptors has likely not occured yet

symptoms usually last 1-3 weeks

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35
Q

what si the meyer overton rule?

A

lipid solubility of the agent is directly r/t its potency

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36
Q

what nerve fiber classification is associated with pain and touch functions?

A

a delta

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37
Q

what are a alpha nerve fibers associated with?

A

motor and proprioception

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38
Q

what is the oil gas partition coefficient of
iso
des
sevo
nitrous oxide

A

iso= 99
des 19
sevo 50
nitrous 1.4

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39
Q

a poorly controlled hyperthyroid patient is undergoing emerency surgery for an appendectomy. at what point would the patient be most likely to experience a thyrotoxic crisis?

A

6-18 hours postop

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40
Q

what is the most sensitive indicator of cardiac ischemia during thoracic surgery when the aorta is cross clamped?

A

TEE

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41
Q

what is most likely to increase the risk of bradycardia during strabismus surgery?
A. hyperventilation
B. hypercapnia
C. presence of cerebral palsy
D. increased depth of anesthesia

A

hypercapnia

due to oculocardiac reflex- can occur due to traction on ocular muscles

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42
Q

hepatic dysfunction due to biliary tract obstruction would be consistent with which lab finding?

A

markedly increased alkaline phosphatase levels

biliary stones are considered a posthepatic cause of hepatic dysfunction and are associated with an increased conjugated fraction of bilirubin, normal to slightly increased aminotransferase enzymes and most notably, markedly increased alkaline phosphatase levels

43
Q

which of the following statements regarding the use of epidural steroids for the tx of low back pain is true?

A

epidural steroids reduce the degree of leg pain and sensory deficit and the use of opioids during the acute phase of the injury

44
Q

symptoms of hyperparathyrodisim are primarily r/t

A

hypercalcemia

45
Q

which of the following ecg changes are associated with cor pulmonale

A

R atrial hypertrophy
-peak p waves in leads II, III, aVF

-R axis deviation and R bundle branch block is usually from RV hypertrophy

46
Q

the underlying cause of organ failure due to DIC is

A

organ ischemia due to thrombosis

47
Q

what is the treatment of choice for myasthenia gravis?

A

thymectomy

48
Q

after an open colon resection, a patient exhibits liver enzymes that are 2x the normal value

A

common and should resolve in 48 hours

49
Q

what is the half life of factor IX concentrate?

A

18-24 hours

50
Q

what antiemetic pretreatment medication would be most likely to increase the risk for reflux?

A

atropine and glyco. -both decrease lower esophogeal sphincter tone and increase the risk for gastric reflux

51
Q

benefits of a single cannister carbon dioxide absorber system over a double cannister system

A

typically easier to change

52
Q

what fibers are the most resistant to anesthetic blockade

A

a alpha

53
Q

how does clonidine reduce blood pressure

A

stimulates alpha 2 receptors and inhibits the release of catecholamines

alpha 2: alpha 1 220:1

54
Q

the primary site for parathyroid hormone and vitamin d mediated calcium reabsorption is the

A

distal tubule

55
Q

what organisms are responsible for the most surgical site infections

A

staph aures and staphh epidermidis

56
Q

greatest degree of protein binding: ketamine, etomidate, versed, propofol

A

propofol > versed > etomidate > ketamine

57
Q

dx of ht failure with reduced ef is defined as

A

ht failure associated with ef under 40%

58
Q

a pt has an allergy to beta lactam antibiotics. what drug would be an inappropriate selection for this patient?
A. vanc
B. penicillin
C. doxycycline
D. flagyl

A

B. penicillin

59
Q

what does des do to csf production

A

increases it

60
Q

when administered for induction, etomidate may cause a slight decrease in BP. if it occurs this is usually due to a decrease in

A

SVR

61
Q

A pt states that he is taking an extended release form of narcan for the treatment of substance abuse disorder. you know this agent should be d/c at least ___ days before opioid administration

A

30 days

62
Q

a patient undergoing emergency surgery is revealed to have a serum digoxin level in a toxic range. which drug would be most likely to help protect against the enhanced cardiac automaticity seen with digitalis toxicity?
A. sux
B. ephedrine
C. calcium
D. fentanyl

A

D. fentanyl

also iso

63
Q

which of the following surgical conditions is common in pt with acromegaly?
A. carpal tunnel syndrome
B. intussusception
C. subdural hematoma
D. detached retina

A

a. carpal tunnel syndrome

64
Q

what is the principal byproduct of deamination of amino acids?

A

ammonia

65
Q

what nerve fiber is responsible for transmiting pain, cold temp and touch

A

a delta

66
Q

which of the following is a metabolite of succinylcholine?

A

succinylmonocholine

67
Q

you are preparing to place an epidural catheter in an obstetric pt who is taking metoprolol. which of the following would be the best formulation for an epidural test dose?

A

lidocaine and fentanyl- using fentanyl and checking for sedation is an alternative

68
Q

how will the chronic admistration of an antagonist affect the number and sensitivity of the receptors it antagonizes?

A

the number and sensitivity of the receptors both increase

69
Q

the 12 led ecg in a pt in the third trimester will most likely exhibit

A

L axis shift.

diaphragm rises and shifts ht up and left. also increased tendency of premature atrial contractions, svt and ventricular dysrhythmias

70
Q

how much csf is normally in subarachnoid space of spinal canal

A

30-80 mL

71
Q

what herbal agent would disrupt plt aggregation for the longest period of time after d/c?
A. ginseng
B. garlic
C. st johns wort
D. gingko

A

B. garlic
up to 7 days after d/c

ginko and ginseng are 36 hours

72
Q

what nerve travels subcut from lateral side of knee joint and is the terminal brach of the femoral nerve?
A. saphenous
B. superficial eproneal
C. deep peroneal
D. sural

A

terminal branch of femoral nerve is the saphenous nerve

it provides sensory innervation to skin of medial lower leg and medial side of malleolus

73
Q

what aortic cross clamp location is associated with the most significant alterations in hemodynamics?

A

supraceliac - alterations in MAP, pulmonary capillary wedge pressure and EF

74
Q

what are common complications of peritoneal dialysis?

A

doesn’t require a graft and the incidence of hypotension is much less

disadvantages: less control over filtraion of solutes, risk of peritonitis, tendency towards hyperglycemia due to glucose in dialysate solution

75
Q

factors to inhibit hpv include

A

inhalation annesthetics, very high or very low PA pressures, hypocapnia, beta adrenergic agonists, vasodilators (nitroglycerin and nitroprusside), pulmonary infection, high or very low mixed venous po2 and ccb

76
Q

what is the standard concentration of epi that is added to LA to prolong duration of epidural block?

A

1:200,000 aka 5 mcg/mL

77
Q

what is the single biggest predictor of problematic intubation in morbidly obese patients

A

neck circumference

78
Q

which is true about inspiratory and expiratory valves?
A. the inspiratory valve closes during inspiration
B. the expiratory valve closes during expiration
C. the valve must open with little pressure and close rapidly
D. the inspiratory valve can be mounted anywhere in the inspiratory side of the circuit

A

D

it does say the valves must open and close rapidly with little to no backflow?

79
Q

the movement of fluid into a cell through the formation of vessicles at the cell membrane is known as

A

pinocytosis- if a cell brings in a liquid solution it is called this

if it is bringing in particulate matter aka cellular debris- it is called phagocytosis

80
Q

what is the oral dose of precedex in a peds pt

A

2-4 mcg/kg

81
Q

what anticholinesterase cross the blood brain barrier?

A

physostigmine (teritary amine)

82
Q

which would be most useful in the treatment of uremic bleeding?

A

desmopressin

83
Q

when inserting a PA catheter via RIJV. at what distance would you expect it to reach RA?

A

15- 25 cm

84
Q

the internal volume of an anesthesia circuit is typically between ___ mililiters per meter of length

A

400-500

85
Q

where is a myelomeningocele typically located?

A

lumbosacral region

86
Q

when bp decreases from 120/60 to 90/60 what happens to cbf

A

it stays the same! (when map is 60-140) as map decreases cbv dilate to keep the blood flow the same

87
Q

what are the 2 most prominent effects of increased age on the pulmonary system?

A

-devrease in the stiffness of lung parenchyma
-increase in the stiffness of the chest wall

88
Q

what arrhythmia would you most likely see in a patient following surgical repair of tetralogy of fallot?

A

RBB

89
Q

what is the formula for the relationship between flow, pressure and resistance

A

flow= pressure/ resistance

90
Q

the extrinsic pathway of the hemostatic response is iniated by the release of a group of proteins known as?

A

tissue factor (forms a complex with factor VII)

91
Q

what fluid should be avoided in a patient undergoing renal transplant?

A

LR- b/c of the K in the solution

normal saline and plasmalyte are both ok. excessive NS -> hyperchloremic met alkalosis

92
Q

most patients femoral nerve is located where in relation to the femoral artery

A

about 0.5 cm lateral to the artery

93
Q

what phase 1 reaction is characterized by reactions that remove electrons from a molecule

A

oxidation

94
Q

which of the following is true about versed (pick 2)
A. it preserves cerebral autoregulaion
B. the appropriate iv dose is 0.08-0.1 mg/kg
C. it is formulated in propylene glycol
d. it decreases the swallowing reflex

A

a. it preserves cerebral autoreuglation
d. it decreases swallowing reflex

dose is 0.02-0.04 mg/kg
it is water soluble an formulated in an acqueous solution causing minimal pain on injection

95
Q

what is a potential disadvantage of frequent tracheal suctioning?

A

disadvantages:
-it can cause atelectasis due to negative pressure
-can decrease fio2 due to entrainment of room air

benefits:
-can remove secretions and result in improved oxygenation and ventilation

96
Q

what law states the diffusion of gas is inversely proportional to the square root of its molecular weight

A

-grahams law

97
Q

what is the most common cause of an acute increase in deadspace in the acute care setting?

A

decreased cardiac output (decreases perfusion to well oxygenated alveoli)

98
Q

what opioid can produce acute dystonic reactions in pt with untreated parkinsons disease?

A

alfentanil (possibly due to disruption of central dopaminergic transmission)

99
Q

you are performing an epidural block and begin threading the catheter. the pt describes tingling in her L leg. you encounter no unusual resistance as you thread the catheter. what should you do?

A

tell the patient this is a normal sensation and proceed

100
Q

semi closed and closed anesthesia circuits are reliant on ___ to maintain safe operations

A

carbon dioxide absorption

101
Q

the gaba receptor is an example of what type

A

ligand gated ionophore

102
Q

what will happen to gas flows on anesthesia machine with electronic flowmeters if the machine loses all power?

A

the gas will continue to flow

the graphical output depends on electrical supply

103
Q

how long does it take for vitamin k to improve PT

A

6-8 hours

104
Q
A

Prodigy (2 decks)

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