Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anesthesiology > ACE 6A > Flashcards

ACE 6A Flashcards

1
Q

What are the four conditions that must be present in order to initiate and sustain a reentrant tachydysrhythmia?

A
  • Unidirectional blockade of a conduction pathway.
  • Two areas of myocardium that have different conductivity or refractoriness. These two areas can then form a closed electrical loop.
  • Sufficient length of the circuit or slowed conduction that allows recovery of the initially blocked conduction pathway.
  • Restimulation of the initially blocked pathway by a retrograde impulse completing a loop
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Of barbiturates, hyperventilation, and mannitol, which is most effective at lowering ICP in patients with acute TBI?

A

Mannitol.

Studies on patients with acute traumatic brain injury have demonstrated that mannitol was more effective in lowering ICP than either barbiturates or hyperventilation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the effects of rapid mannitol infusion?

A

Large doses or rapid administration can produce relaxation of vascular smooth muscle. This may result in intracranial hypertension and systemic hypotension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Via what mechanisms does appropriately-administered mannitol decrease intracranial hypertension?

A
  • diffusion of water from the brain into the blood
  • decrease in CSF production
  • decreased blood viscosity which produces acute vasoconstriction in areas of the brain with intact autoregulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How long does the effect of mannitol last?

A

Six hours (with peak effect at one hour).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the inheritance pattern of vWD?

A

autosomal dominant

(except for Type 3 which is autosomal recessive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the actions of vWF?

A

forms adhesive bridge between platelets and subendothilial structions

acts asa carrier of factor VIII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the treatment of choice for Type 1 vWD?

A

1st line: Desmopressin

2nd line: Factor VIII-vWF concentrates

Cryo is no longer recommended due to the risks of infectious transmission.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

For which type of vWD is cryoprecipitate recommended as therapy?

A

Cryo is NO LONGER RECOMMENDED for any type of von Willebrand’s disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the different types of von Willebrand’s disease?

A

Type 1 - partial quantitative deficiency of vWF and factor VIII)

Type 2 - qualitative defects (there are four subtypes)

Type 3 - severe or complete deficiency of vWF and moderately severe factor VIII deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the mechanism of action of DDAVP?

A

Stumulates release of endogenously synthesized vWF from the endothelium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does progesterone stimulate respiration in pregnancy?

A

Increases the sensitivity to CO2 within the central respiratory center.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a normal PaCO2 in pregnancy?

A

30 mm Hg

Presents by the end of the 1st trimester and persists throughout pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a normal maternal pH and HCO3- at 35 weeks gestation?

A

pH 7.44

Bicarb decreased down to 20.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does CN XII innervate?

A

Hypoglossal nerve (CN XII): motor innervation to intrinsic and extrinsic muscles of the tongue (except the palatoglossus muscle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does CN V3 provide to the tongue?

A

Trigeminal nerve (CN V): mandibular division (V3) forms the lingual nerve that provides general sensation to the anterior two thirds of the tongue and floor of the mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does CN IX innervate?

A

Glossopharyngeal nerve (CN IX) provides:

  • taste to posterior one third of the tongue
  • sensation to the posterior one third of the tongue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does CN VII contibute to the tongue?

A

Facial nerve (CN VII): branch forms the chorda tympani nerve that provides taste to the anterior two thirds of the tongue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does CN X contribute to the tongue?

A

Vagus nerve (CN X): internal laryngeal branch of the superior laryngeal nerve provides taste sensation to the root of the tongue and epiglottis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What adverse reaction to transfusion is greatly reduced by leukocyte reduction of blood products?

A

Febrile transfusion reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When is leukocyte reduction most effectively performed?

A

It is most effective when performed prestorage when the filter is incorporated into the collection bag at the blood center.

The efficiency of leukocyte filtration has been shown to be decreased by slow filtration rate and at room temperature, conditions normally present when the patient is receiving blood at the bedside.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is amiloride?

A

a potassium-sparing diuretic that has been useful in treating both hypertension and hypokalemia in patients with primary hyperaldosteronism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the mechanism of primary hyperaldosteronism?

A

In primary hyperaldosteronism, there is an overproduction of aldosterone that is not related to renin production and is not responsive to sodium loading.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are causes of primary hyperaldosteronism?

A
  • adrenal gland adenoma,
  • adrenal hyperplasia,
  • glucocorticoid-responsive aldosteronism, a rare genetic disorder occurring usually in patients less than 20 years old.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the treatment for primary hyperaldosteronism?

A

For unilateral adrenal gland adenoma or adrenal hyperplasia, surgical adrenalectomy is the treatment of choice due to a very high (almost 100%) resolution of high blood pressure and hypokalemia.

For bilateral disease, spironolactone (the mineralocorticoid receptor antagonist) is the optimal treatment.

For confirmed glucocorticoid-responsive aldosteronism: give a long-acting glucocorticoid (dexamethasone or prednisone). If insufficient, add spironolactone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is eplerenone?

A

A mineralocorticoid receptor antagonist that is more selective than spironolactone with fewer antiandrogen and progesterone agonist effects. However it only has 60% of the mineralocorticoid receptor antagonist effect of spironolactone and thus is not first-line therapy for primary hyperaldosteronism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What causes ischemic mitral regurgitation?

A

LV remodeling most often.

Less frequently, papillary muscle rupture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Regarding mitral regurgitation: does exercise-induced pulmonary edema occur only in the presence of severe mitral regurgitation?

A

No.

Due to the dynamic nature of mitral regurgitation, even small amounts of regurgitation seen at rest may result in pulmonary hypertension and pulmonary edema during exercise or other situations associated with an increase in catecholamines.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How does biventricular pacing in a patient with MR affect the degree of regurgitation?

A

Cardiac resynchronization using biventricular pacing can immediately reduce mitral regurgitation by altering ventricular distortion and reducing tethering of mitral leaflets in patients with chronic heart failure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What medications are the medications of choice for patients with hypertension and MR? Why?

A

ACE inhibitors and ARBs are the medications of choice.

They reduce left ventricular afterload and prevent ventricular remodeling.

Note: Beta-blockers also may be beneficial in preventing or reducing ventricular remodeling.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the diameter index safety system?

A

Prevents interchanging the connections for different gases from the wall outlet to the anesthesia machine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What safety system is associated with the connections of the gas wall outlet to the anesthesia machine?

A

Diameter Index Safety System

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What safety system prevents the attachement of the wrong gas cylinder to the yoke on an anesthesia machine?

A

Pin Index Safety System

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the pin index safety system?

A

Used on size E and smaller cylinders, it is designed to prevent the attachment of the wrong gas cylinder to the yoke on an anesthesia machine (which could result in the administration of an hypoxic gas mixture).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What type of renal failure do the aminoglycosides cause?

A

Nephrotoxin induced acute tubular necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What dosing factors increase the risk of nephrotoxicity of aminoglycosides?

A

Counterintuitively: higher frequency of administration (e.g., 200mg q6hr is higher risk than 400mg q12hr)

More obviously:

  • high total daily dose
  • duration of therapy
  • high serum concentrations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What can be given along with aminoglycosides to decrease the risk of nephrotoxicity?

A
  • concurrent administration of beta-lactam antibiotics (eg, penicillins, cephalosporins)
  • dietary supplement with calcium
  • concurrent administration of calcium channel blockers
  • possibly vitamin E, C and other antioxidants
38
Q

What provides somatic innervation of the anterior abdominal wall?

A

Thoracolumbar nerves running deep to the internal and external oblique muscles within the transverse abdominis fascia as well as the lateral and anterior cutaneous branches in the skin.

39
Q

What is the pathway of visceral pain from the distal esophagus to the splenic flexure of the colon?

A

Visceral afferent fibers travel (within the same sheath as efferent sympathetic fibers) to the celiac plexus and then to the spinal cord through the greater, lesser, and least splanchnic nerves.

40
Q

How does the efficacy of celiac plexus block compare between pancreatitis vs pancreatic malignancy pain?

A

Neurolytic celiac plexus block for chronic, nonmalignant abdominal pain (eg, pancreatitis) appears to lack the prolonged efficacy demonstrated for the pain associated with upper abdominal malignancies. This may relate to the longer follow-up in patients with noncancer pain.

41
Q

What salient features distinguish a CRPS from a simple neuralgia?

A

The presence of sympathetic nervous system dysfunction manifesting as abnormal sweating, goose bumps, temperature changes, or edema

42
Q

What is the primary difference in CRPS I and CRPS II?

A

CRPS I is diagnosed in the absence of a known nerve injury.

CRPS II is diagnosed in the presence of a known nerve injury.

43
Q

What type(s) of technique will provide pain relief for ONLY the 1st stage of labor?

A

Lumbar sympathetic block

Paracervical block

44
Q

What is the main concern with providing paracervical block for labor pain?

A

Aside from the fact that it will only cover 1st stage labor pain, it is associated with fetal bradycardia.

45
Q

What technique blocks ONLY the 2nd stage of labor pain?

A

Pudendal block

46
Q

What causes pain in the first stage of labor?

A

Visceral pain resulting from cervix dilation, distention of the lower uterine segment during contractions.

47
Q

What is the pathway of the pain fibers involved in the 1st stage of labor?

A

These visceral afferent fibers from the cervix and lower uterus join the sympathetic chain at L2-L3 and enter the spinal cord at T10 - L1.

48
Q

What is the pathway of the pain fibers involved in the 2nd stage of labor?

A

Somatic nerve fibers from the 2nd through 4th sacral nerves which are included within the pudendal nerve

49
Q

What causes pain in the 2nd stage of labor?

A

Second-stage labor pain is caused by distention of the vagina, perineum, and pelvic floor as the fetal head descends through the birth canal.

50
Q

What is the most likely etiology of isolated mitral stenosis?

A

rheumatic fever

51
Q

What is the normal mitral valve orifice area?

A

4 - 6 cm2

52
Q

What orifice areas are associated with mild and severe mitral stenoses?

A

Mild = 2cm2

Severe < 1cm2

53
Q

Left atrial enlargement in mitral stenosis leaves a person at increased risk for what complication?

A

Thrombus formation and systemic embolization

54
Q

How does polycythemia affect aPTT?

A

Collection tubes used for PTT determination contain a specific amount of anticoagulant; failure to adequately fill the blood collection tube will result in a relative excess of anticoagulant, which may cause prolongation of the PTT. A decreased amount of plasma in the blood, as occurs with polycythemia, also may result in excess anticoagulant, resulting in prolongation of the PTT.

55
Q

What tests the intrinsic coagulation pathway?

A

aPTT

56
Q

What factor is the only factor whose deficiency will not prolong aPTT?

A

Factor VII

57
Q

In the absence of heparin therapy, prolongation of the PTT usually means what?

A

It usually reflects an inherited disorder such as hemophilia, vWD, or antiphospholipid antibodies.

58
Q

What is the relevance of the prolonged aPTT found in patients with antiphospholipid antibodies?

A

It is a laboratory anomaly and does NOT reflect coagulation defect. Patients with APA are often hypercoagulable.

59
Q

How does FRC compare between neonates and adults?

A

Neonates have a smaller FRC on a mL/kg basis.

60
Q

What is the main advantage from the addition of sodium bicarbonate to lidocaine?

A

Increased density of the sensory blockade.

The decreased time for the onset of analgesia is actually somewhat controversial.

61
Q
A
62
Q

Hepatic encephalopathy occurs most frequently in association with what physiologic changes in liver disease?

A

Portal hypertension and diversion of blood away from the liver.

63
Q

What are the earliest changes of hepatic encephalopathy?

A

nighttime wakefulness with daytime somnolence, impaired cognitive testing scores

though these are often subclinical and commonly recognized only in retrospect.

64
Q

What respiratory parameters are unaffected by spinal anesthesia?

A
  • Tidal volume
  • maximum inspiratory volume
  • negative intrapleural pressure during maximal inspiration
  • arterial blood gases
65
Q

What respiratory parameters are decreased by spinal anesthesia?

A
  • Maximum breathing capacity
  • Vital capacity
  • Expiratory reserve volume
  • maximum expiratory volumes
  • maximum intrapleural pressure during forced exhalation
66
Q

Why are expiratory functions altered by spinal anesthesia?

A

Due to impairment of the anterior abdominal muscles.

67
Q

What is the difference between neurofibromatosis 1 and 2?

A

NF2 almost always has bilateral acoustic neuromas whereas NF 1 does not. NF2 does not have plexiform lesions but NF 1 does.

68
Q

What are the risks of neurofibromatosis and pregnancy?

A

Number and size of neurofibromas increase during pregnancy.

If they grow in pelvis or abdomen they can cause dystocia and obstructed labor increasing need for c-section risk.

they also are more likely to have:

  • hypertension
  • renal artery stenosis
  • HELLP syndrome (Hemolytic anemia, Elevated Liver enzymes, and Low Platelet count)
  • maternal vascular complications
  • intrauterine growth restriction
  • preterm labor
  • spontaneous abortion and stillbirth
69
Q

What is a Lisch nodule?

A

benign melanotic iris hamartomas seen in neurofibromatosis type 1

70
Q

What is the pathophysiology of neurofibromatosis 1?

A

It is characterized by a derangement in the growth and development of neural crest elements (Schwann cells, melanocytes, and fibroblasts). It leads to the proliferation of benign tumors called neurofibromas that are made up of Schwann cells, fibroblasts, and mast cells.

71
Q

What is von Recklinghausen disease?

A

Neurofibromatosis type 1

72
Q

What are some physical findings in a patient with von Recklinghause disease?

A
  • six or more café-au-lait spots larger than 5 mm in prepubescent and larger than 15 mm in postpubertal individuals
  • freckling in the axillary or inguinal regions
  • optic glioma
  • two or more Lisch nodules (benign melanotic iris hamartomas)
  • presence of distinctive bony lesions (thinning/dysplasia of the long bone cortex or sphenoid bone)
73
Q

What is the significance of a plexiform lesion in neurofibromatosis type 1?

A

these lesions can undergo malignant change to become neurofibrosarcoma

74
Q

What are some clear advantages of the infraclavicular block?

A
  • Bilateral blocks can be performed without fear of phrenic nerve blockade
  • It does not require supplemental blockade of the musculocutaneous nerve
  • It is ideal for continuous catheter fixation and long-term infusion
  • It is conducive to the use of ultrasound guidance
  • Placement can be done without abduction of the arm (an advantage in this patient)
75
Q

What is diabetic cardiomyopathy?

A

Impaired ventricular relaxation which can progress to increased LV filling pressures and CHF

76
Q

Define the following doppler terms for mitral imaging:

A, E, e’, a’

A

A = velocity at atrial contraction

E = peak early filling velocity

e’ = velocity of mitral annulus early diastolic motion

a’ = velocity of mitral annulus motion with atrial styole

77
Q

What is a normal E/e’ ratio?

A

< 10

78
Q

What does an E/e’ ratio > 10 correspond with?

A

High filling pressures and diastolic dysfunction

79
Q

What is the normal relationship between E:A on doppler mitral inflow?

A

E > A with an E/e’ ratio < 10

80
Q

What is the normal e’:a’ ratio?

A

e’ is always greater than a’.

In diastolic dysfunction, a’ remains larger than e’ regardless of severity (where as there can be pseudonormalization of the E:A ratio)

81
Q

In the absence of cardiac symptoms, what findings might warrant a diabetics referral for a TTE?

A

Significantly elevated A1c levels and a h/o type II diabetes for more than four years.

82
Q

Describe the clinical symptoms of diabetic cardiomyopathy.

A

There usually aren’t any.

Even when diabetic cardiomyopathy has progressed to heart failure, left ventricular systolic function is usually preserved; the ejection fraction is usually greater than 50%. Fewer than 50% of patients with severe systolic or diastolic dysfunction have symptoms. The only symptom may be mild exercise intolerance, and the significance of this change can be missed.

83
Q

What cardiac conditions are associated with the greatest risk of adverse outcome if endocarditis occurs (and thus should received IE prophylaxis)?

A
  • presence of prosthetic valve or materials
  • prior history of infective endocarditis
  • unrepaired cyanotic congenital heart disease (eg, unrepaired tetralogy of Fallot)
  • recently repaired (< six months ago) congenital heart disease using prosthetic material
  • repaired congenital heart disease with residual defects
  • heart transplant with evidence of valvulopathy
84
Q

What electrolyte abnormalities is lithium therapy associated with?

A

hypokalemia

hypercalcemia

It may also block ADH and cause a nephrogenic diabetes insipidus

85
Q

Lithium has what effect on MAC and why?

A

It decreases MAC because it decreases the release of neurotransmitters in the CNS

86
Q

Lithium has what effect on benzos and barbiturates?

A

It prolongs their effects.

87
Q

Via what mechanism does lithium affect neuromuscular transmission?

A

It inhibits it by activating potassium channels

88
Q

How are neuromuscular blockers affected by lithium therapy?

A

both depolarizing and nondepolarizing NMB are prolonged by lithium

89
Q

How does remifentanil affect EEG activity?

A

Like other opioids it will decrease BIS values but a brief infusion of very-high-dose remifentanil will decrease EEG activity in normal brain tissue but significantly increase single and repetitive spike burst activity in the epileptogenic area. This can help the surgeon localize the epilepctic focus.

90
Q

What is duloxetine?

A

A pain medicine approved for treatment of painful diabetic peripheral neuropathy. It inhibits reuptake of serotonin and norepinephrine.

91
Q

Where does duloxetine act to reduce pain?

A

The periaqueductal gray matter and rostral ventromedial medulla contain noradrenergic and serotonergic (as well as opioidergic) neurons that project down to the dorsal horn of the spinal cord. In the spinal cord, activation of alpha2-adrenergic receptors and a subset of serotonin receptors inhibits the presynaptic release of excitatory neurotransmitters from primary afferent nociceptors and also inhibits the postsynaptic depolarization of second-order projection neurons that ascend to transmit the nociceptive signal cephalad. It is believed that duloxetine works by increasing the amount of serotonin and norepinephrine available at these inhibitory synapses.

Anesthesiology (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions