ACE 2011 Flashcards
What type of tocolytic agent is associated with hypoglycemia in neonate
Beta agonists like terbutaline
Combined ventricular output in a normal fetus through foramen ovale, ductus arteriosus, and pulmonary artery
Foramen ovale: 33%
Ductus arteriosus: 45%
Pulmonary artery: 11%
Gold standard for diagnosis of heart failure
Echocardiogram
Nerve that becomes the medial and lateral plantar nerves
Posterior tibial nerve
Nerve that innervates web space between first and second toes
Deep peroneal nerve
Nerve that innervates the dorsum aspect of foot
Superficial peroneal nerve
Nerve that innervates the lateral aspect of foot
Sural nerve
Absolute criteria for obsolescence of an anesthesia machine
- Absence of minimum oxygen ratio device to deliver N2O
- Absence of oxygen fail safe device
- Absence of oxygen supply pressure failure alarm
- Absence of vaporizer interlock device
- Absence of PISS
- Absence of DISS
- Presence of connectors in scavenging system that are same diameter as breathing system
- ## Presence of vaporizer with clockwise rotation of dial that increases concentration
Preop fasting guidelines for breast milk
4 hrs
Preop fasting guidelines for infant formula
6 hrs
Blood tests to identify pathophysiology of anaphylaxis
Plasma histamine and tryptase concentrations
Blood sample to detect tryptase elevation should be obtained when after severe anaphylaxis
30 min to 2 hrs after
Dermatomal range for adequate anesthesia for c section
T4-S4
How does epidural analgesia for labor affect maternal core temperature?
Increases it, usually by less than 1 degree C
Ideal positioning of a central venous catheter to aspirate venous air embolism can be determined by what kind of EKG wave?
Biphasic P wave indicating central venous catheter is in the right atrium
Treatment for Symptomatic hypercalcemia
1) IV infusion of normal saline
2) loop diuretic
3) bisphosphonates
4) IV calcitonin for life threatening hypercalcemia
What is the association of SLE with platelet count?
Thrombocytopenia
Most common cardiac problem associated with SLE
Pericarditis. SLE also associated with HTN, coronary atherosclerosis, valvular disease, tamponade
How do systolic pressure recordings change the more distal it is measured?
The more distal the pressure is measured, the greater the systolic pressure will be recorded because branch points along the way increase the amplification
What condition in a patient makes hemabate a contraindication?
Pulmonary hypertension because hemabate (prostaglandin) increases pulmonary artery pressures
Plasma local anesthetic concentrations from most to least in terms of site of injection
Intercostal > caudal epidural > lumbar epidural > brachial plexus > peripheral nerve > subcutaneous tissue
EMLA (eutectic mixture of local anesthetics) contains which 2 local anesthetics
Lidocaine and prilocaine
Prilocaine is metabolized to what?
O-toluidine, which may produce methemoglobinemia
Phrenic nerve blockade occurs in how many patients receiving supraclavicular brachial plexus block?
30-50%
Normal P50 for adult is
27 mmHg
Types of shock
Hypovolemic
Cardiogenic
Distributive (sepsis, neuro, anaphylaxis)
Obstructive (tamponade, PE, tension ptx)
Median nerve’s anatomical relationship to ulnar nerve in the axilla
Median nerve is superior to ulnar nerve
What nerve innervates the dorsal webspace between thumb and forefinger
Radial n
Perineum, pelvic floor, anal skin are innervated by what nerves?
Pudendal nerves
What should the ETT leak be?
Between 20-25 cm H2O
Single most important patient attribute affecting risk of developing postdural puncture headache.
Age, highest incidence in late teens to twenties, incidence decreases with increasing age
Type of pain associated with pancreatitis, cancer, trauma
Nociceptive pain
Type of pain resulting from damage or dysfunction of normal pain pathways
Neuropathic pain
Classes of drugs generally used to treat neuropathic pain
TCAs, anticonvulsants, NMDA antagonists
Initial intervention when HR less than 60 in a neonate
Chest compressions, consider intubation
Intervention if chest compressions do not raise HR above 60 in a neonate resuscitation
Epinephrine
Avg hemoglobin in a healthy term neonate
16.8 g/dL
Nadir for hemoglobin after birth for newborn is at how many weeks?
8-12 weeks, hgb 8-9 g/dL, rbc lifespan is 80-100 days in full term neonate
Which volatile agent is preferred in patients with liver disease and why?
Isoflurane, vasodilates hepatic circulation to maintain hepatic blood flow. Sevo and des also maintain hepatic blood flow
Which volatile agent decreases hepatic blood flow
Halothane
Primary blood supply to thoracolumbar portion of spinal cord
Artery of Adamkiewicz, branching off the aorta in the T9-12 region
Best initial management strategy in an unstable patient with Stanford type A aortic dissection with a echo showing large pericardial tamponade?
Immediate surgical repair. Pericardiocentesis is contraindicated because it can produce a pressure gradient between dissection and pericardial space which results in increased blood flow into pericardial space and extension of aortic dissection
Laboring patient starts experiencing respiratory distress, cardiovascular collapse, coagulopathy, pulmonary hypertension and RV failure
Amniotic fluid embolism
Fetal acidemia is defined as
pH < 7.2
Metabolic or respiratory acidemia is associated with increased risk of neonatal complications
Metabolic