ACE exam 3 Flashcards
cervical radiculopathy plus Horners syndrome, next step?
CXR r/o Pancoast tumor
HLA B27 dx?
ankylosing sponylitis or IBD
Muscles need goes through for an erector spinae block
trapezius, rhomboid, erector spinae
ocular perfusion pressure
MAP - IOP
Desmopressin inc release of what factor?
VIII
concern for anesthesia w/ Renal cell carcinoma?
invasion into IVC, renal v, RA
what PFT is indicative of severity in cystic fibrosis?
FEV1
What time of day should cystic fibrosis case be done?
Later in the day -> let chest PT clear out accumulation of ON thick secretions
LMA v ETT for cystic fibrosis?
If can LMA to avoid instrumentation of airway
-if ETT use bigest possible for suctioning
which muscle relaxant is likely to cause serotonin syndrome w/ other 5HT meds?
Cyclobenzaprine
-b/c acts similarly to TCAs -> so serotinin receptor binding
MOA of baclofen
GABA B agonist
What eyedrops interfere w/ succinylcholine?
echothiophate and isoflurophate
-inhibit serum cholinesterase
Normal dibucaine number
80
MCC of ESRD leading to kidney transplant in the US
diabetes
Pain in first and second stage of labor
first: T10- L1
second: S2-S4
recent stent, but needs urgent repair, what briging therapy appropriate when clopidogrel needs to be stopped 5 days preop?
Cangrelor
CAN GrelOr
Pulmonary alveolar proteinosis homeostasis d/o of?
Surfactant -> buildup of lipoprotein rich substance in alveoli
What is in vaping liquid that can lead to bronchiolitis obliterans?
Diacetyl -> it’ll kill you
DIE
ANti-glomerular basement membrane antibodies
Goodpastures
effect BM in lung and kidneys
In CO2 absorber, w/ soda lime and KOH, how do the concentrations change?
KOH doesn’t change -> it’s a catalyst
-soda lime dec and gets consumed
First drug to start in peds HF?
ACE inh
(BB second)
fever: TRALI or TACO?
TRALI
Spinal cord stimulators and surgery
-preop: turn down to lowest setting and then turn off
-intraop: bipolar cautery, if monopolar pad far from SC stimulator leads
-postop: interrogation
Clevidipine metabolism
esters blood and tissue
SIADH labs
Serum osm < 275
Serum Na < 135
U Na > 30
Urine osm > 1–
Occupational Health says what is the maximum acceptable workplace exposure to halogenated volatile anesthetics?
2 ppm
Antiplt medication that reversibly inhibits plt aggregation?
Eptifibatide
It’s fibbing b/c its reversible
Ticagrelor
Vorapaxar
Cangrelor (it can go b/c reversible)
Irreversible plt medication
ASA
Clopidogrel
Prasugrel
-praying but nada b/c irreversible
N/V neuraxial v IV?
same risk!
What are the only reasons to quench an MRI?
-metallic object on magnet
-fire
-earthquake
**if pt needs CPR no need to quench, just remove them
succinylcholine recovery time and pregnancy
unchanged!
RF for sudden cardiac death in HOCM
-LV apical aneursym
-dec LV function (<50%)
-extensive gadolinium enhancement on cardiac magnetic resonance imaging
youngest age a double lumen tube can be used
8
most effective drug in smoking cessation
Varenicline
TEG value assoc w/ thrombin generation
R time
What does K time represent on TEG?
rate of fibrin cross-link formations and interaction b/w fibrin and plts
Goal MAP for SCI
> 85 for 7 days after injury
incomplete spinal cord injury, best next step?
surgical decompression
HFrEF tx
Angiotensin receptor-neprilysin inhibitors
ASA III v IV
III: poorly controlled dx
IV: severe dx that is a constant threat to life
Drugs where metabolism is dept on hepatic blood flow
high hepatic extraction ratio!
-propofol, sufent, morphine, lidocaine
Drugs where metabolism is indpt of hepatic blood flow
wafarin
phenytoin
alfentanil
minimum wait time to redose roc after giving sugammadex
5 minutes
-but will take 4 minutes to onset, and duration of action is only about 15 minutes
if signifcant difference b/w upper extremity BP, where should one put an a line?
the limb w/ the higher BP -> more accurate to what the brain is seeing
When is aprepitant supposed to be given?
1 hour before induction of anesthesia
Difference of Oliceridine from other opioids?
It is selective for mu opiod receptors -> minimizing other SE compared to other opioids
myocardial injury after noncardiac surgery
-inc trops w/o symp or EKG changes -> inc 30 day mortality risk
Andexanet alfa is a reversal agent for?
Apixaban and rivaroxaban
Metochlopramide and pheo
avoid!
What type of stents have highers risk of thrombosis more than 1 year after implantation?
1st generation drug eluting stents
which stents are most likely to restenose?
bare metal stents
What neurmonitoring should be done w/ TAA?
MEPs b/c concern for ischemic in anterior spinal cord -> MEPs monitor
When giving hydroxycobalamin for BP control, what lab value is likely to be inaccurate?
Hg
criteria for ON admission after T&A
severe OSA (apnea-hypopnea index > 10)
-sleep disturabnce
-age < 3
-craniofacial abnormalities
-living 1 hour away or unstable housing
-postop problems (fever, PONV, no oral intake)
-coagulpathy
-extreme obesity (> 98th %ile)
What monitor is reliable w/ LVAD?
EKG
-pulse ox and NIBP cuff req pulsatile flow
after catheter PDA closure, peds pt gets SOB, difficulty feeding due to choking and coughing, why?
RLN injury 2/2 nerve running near where PDA closure was
How long after spinal drain placement can IV heparin be given?
1 hour
sign of human trafficking
-pt doesn’t speak english and person with them doesn’t want them to use a translator
How to do uterine relaxation during EXIT procedure?
volatile anesthesitc
Meralgia paresthetica
injury to LFCN (L2-3)
Which chemotherapy agent prolongs NMB?
cyclophosphamide
Pt is a poor CYP2C19 metabolizer, what antiplt to avoid?
Clopidogrel
Anesthesia concerns for pt w/ Epidermolysis bullosa
-sensitive skin on face, can have perioral scarring, enlarged epiglottis
-IV induction, inh too much contact w/ mask and face
-intranasal intubation (resp mucosa, so less scarring of nasal passages)
-avoid LMAs -> friction in perioral area
-clip on pulse ox
-protective layer b/w pt and BP cuff
-may have a difficult airway
Nicardipine CBF
-inc CBF while dec systemic pressure
-inc SV and coronary blood flow
roc onsent and off set in age > 80
slower onset
and slower off set (longer acting)
What can cause torsades when given w/ methadone?
Metochlopramide and Ondansetron
What factors affect block height?
-age (less CSF)
-baricity
-pregnancy (higher level)
Hemochromatosis
dx of iron metabolism -> body is overloaded in iron
-affects liver, pancreas, and heart
-assoc w/ diabetes
Diff b/w addiction and pseudoaddiction
-in pseudoaddiction -> behavior extinguished once adequate pain control is achieved
-true addicts continue drug seeking even once pain has been relieved
Nocebo effect
adverse outcomes triggered by pt expectations that the treatment will be harmful
SAH and hypoNa why?
Cerebral Salt Wasting
w/ ruptured aneurysm, postop?
Follow troponins -> may indicate cardiac issues that aren’t presenting
what dx is assoc w trigeminal neuralgia?
MS
what arrythmia is common w/ Fontan physiology?
intra-atrial reentrant tachycardia
-basically redo anatomy so only 1 functioning ventricle
what other use has bupropion/naltrexone been approved for?
chronic weight management
a line dx?
AR
a lline dx?
HOCM
gabapentin preop inc risk of what postop?
dizziness
visual changes
Difference b/w subcutaneous ICD and typical AICD?
-just subq, no venous access -> so more susceptible to electromagnetic interference
-has only pacing possibilities for 30 sec after shock, no longer PM
-used in pts who can’t get vascular acces or prothrombic
SAME: same response to magnets
Frailty components
-unintentional weight loss
-weakness
-exhaustion
-slowness
-low activity
–> useful for predicting poor outcomes postop -> postop delirium higher in frail pt, risk of D/c to not home 5x increase
Factor V Leiden
hypercoag
-makes factor V resistant to degradation by protein C
Time to d/c ER naltrexone prior to surgery?
4 weeks
Recommendation for anesthesia for c/s when women want to breastfeed
neuraxial
TURP w/ shoulder pain during procedure and abd distention
bladder perforation
What prevents the wrong gas cylinder from being connected to the anesthesia machine?
pin index safety system
What is the diameter index safety system used for?
hose-to-wall and hose-to-machine connections for different medical gases
RF for warfarin induced skin necrosis
protein C def
protein S def
antiphospholipid antibodies
Indications for intraop cell salvage
-EBL will be > 1L
2. blood loss confined: cardiac, vascular
3. diff obtaining homologous blood
Changes in blood banked blood compared to cell salvaged blood
-2,3 DPG dec
-pH dec
-K inc
-dec resistance to osmotic stress
-microaggregate formation
urgent intracranial surgery needed for pregnant week 28 woman, modification to anesthesia needed?
RSI
most effective neuroprotectic strategy during aortic arch reconstruction w/ temporary interruption of cerebral blood flow?
deep systemic hypothermia
what can you do to increase cerebral rSO2?
inc MAP
**position has NO impact
NSAIDs (ketorolac) have a ceiling effect for?
Analgesia
NSAIDs (ketorolac) have no ceiling effect for
GI bleeding, AKI
What color goggles for Argon lasers?
Orange
-like ARG -> pirate -> scurvy -> need oranges
What goggles for Nd:YAG laser?
GREEN
Rgoggles for CO2 lasers/
Clear
potassium titanyl phosphate lasers, what color goggles?
RED
-PQR -> Red goggles for Potassium
if pt has anterior mediastinal mass and onc is saying 911 OR, next step?
delay case get echo and CT scan first!
-need to assess options and see extent of compression before anesthesia
Coag factors dec in pregnancy
XI XIII
Coag factors unchanged in pregnancy
II, V
anticoag unchanged in pregnancy
protein C
-CEE? i’m unchanged
Anticoag factors dec in pregnancy
ATIII, protein S
So sad i’m decreased S
RF for chronic opioid use postop in opioid naive pt
age > 50
-male sex
-chronic benzo use or antidepressant use
-hx of substance use
-lower socioeconomic status
-type of surgery: TKA, open chole, total hip, mastectomy
How are roc and cistatracurium dosed?
ideal body weight
RF for postop cognitive dysfxn
vascular dx
What are vagal nerve stimulators used for?
refractory epilepsy and major depression
Anesthesias concerns w/ vagal n stimulators
-can affect VC -> inc risk of aspiration
-inc risk of central OSA
-same concerns as PM w/ cautery
What valvular pathology is better tolerated in pregnancy?
AR -> b/c SVR is low and HR is high in pregnancy
-stenotic lesions are difficult b/c dec in SVR limits coronary BF and fast HR limites LV filling
