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Anesthesia > Advanced Physical Health Assessment > Flashcards

Advanced Physical Health Assessment Flashcards

0
Q

What was the name of the maverick surgeon in Scream A?

A

Dr. Liston

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1
Q

What best describes the source of the following statement - ‘Perform and document a thorough pre-anesthesia assessment and evaluation’

A

AANA Standard I

AANA Scope of Practice

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2
Q

What 4 diagnostic data is recommended to review in the ASA task force preoperative guidelines?

A

LERC

Laboratory, EKG, radiographs, and consultation

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3
Q

How many steps are recommended by the ASA for a preoperative visit?

A

6

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4
Q

Who was the 1st nurse anesthetist?

A

Sister Mary Bernard

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5
Q

How many anesthetics did Alice MaGaw deliver without a single complication in her published article on anesthesia?

A

14,000

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6
Q

What are 6 skills for engaging the patient?

A

PELPEE

Professionalism, empathy, lay language, use of personal touch, eye contact, eye level

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7
Q

What is the number one thing for reducing surgical site infections?

A

handwashing

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8
Q

What are the 7 steps of the basic physical exam?

A

Airway, heart sounds, lung sounds, vital signs, height/weight, neuro exam, and verify mobility/disability

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9
Q

Which of the following is an ASA4 patient?

A

…a 57 yo Female with PVD, symptomatic CHF who is in a wheelchair and on hemodialysis

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10
Q

What is the cited mortality rate for a ASA3 patient?

A

0.027%

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11
Q

What is the Mallampati of this patient?

A

Class III (visualization of only the base of the uvula)

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12
Q

What is the 332 rule?

A

3 fingers mouth opening, 3 fingers between the tip of chin and the hyoid bone, 2 fingers between the hyoid bone and the top of the thyroid cartilage

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13
Q

What does LEMON stand for?

A

Look externally, evaluate the 332 rule, Mallampati, Obstruction, Neck mobility

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14
Q

What are 3 abnormal upper airway sounds?

A

snoring, stridor, croup

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15
Q

What are 3 abnormal lower airway sounds?

A

Wheezing, rhonchi, rales

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16
Q

What is the most common heart murmur?

A

mitral regurg

~ 5:10,000

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17
Q

What is the most serious heart murmur?

A

aortic stenosis
~ 1-2%
50% of symptomatic patients will not survive 2 yrs

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18
Q

What are the primary steps of a basic neurological exam?

A

Walking and balance, PEARL, ROM, Grip and motor stength X 4, symmetry - facial droop, tongue midline;
vision, speech, orientation (person/place/date/time)

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19
Q

Your patient plays half court basketball. What is his METS score?

A

> 10

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20
Q

Your patient has type 2 diabetes and HTN. What BP represents HTN?

A

140/90

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21
Q

What is the equation to calculate BMI?

A

kg/m2 (squared)

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22
Q

What are 6 effects of smoking?

A

addiction to nicotine, risk of other drug use, lower level of lung function, decreased rate of lung growth, heart disease, stroke, increased risk of lung ca, 3X more likely to use alcohol, 8X more likely to use marijuana, 22X cocaine, fighting, unprotected sex

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23
Q

What are 6 effects of drug use on anesthesia?

A

marijuana - tachycardia, labile BP, HA, euphoria, dysphoria, depression, anxiety, panic attacks, psychosis, poor memory, decreased motivation

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24
Q

What are 6 effects of ETOH on anesthesia?

A

CV dz, cirrhosis, enzyme induction or depression, HTN, increase risk of vomiting, behavioral changes, decreased LOC

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25
Q

What are 5 common things patients withhold info about?

A

NPO status, drug abuse, HIV status, smoking, alcohol consumption, medication compliance

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26
Q

What are 5 red flags regarding the patient’s airway?

A

Increased Mallampati class, decreased thyromental distance, obesity, decreased head/neck mobility, small mouth opening

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27
Q

What remains the number 1 cause of death from anesthesia?

A

Malignant Hyperthermia

Treatment: dantrolene (give early)

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28
Q

Significant medical history of Case in class with young girl

A

drugs, alcohol, full stomach, risk of ulcers, pregnant?, HepC, HIV, s/p trach from major car accident

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29
Q

Implications of medical history on the anesthetic plan:

A

enzyme induced, potential difficult stick, risk of adverse event if they did drugs day of surgery, risk of aspiration or full stomach, alcohol, risk of tracheal stenosis from prior trach

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30
Q

Current NPO guidelines

A

8 hrs for big breakfast
6 hrs for light breakfast, solids, non human milk
2 hrs for clear liquids

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31
Q

Medication to avoid in this patient

A

Toradol d/t risk of ulcer

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32
Q

What is HIPAA and how does it apply?

A

The Health Insurance Portability & Accountability Act of 1996
protects individuals medical history from being divulged to others without the patient’s permission

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33
Q

AAA repair carries a pulmonary complication risk of ____ % and a cardiac risk of ____ %

A

6.9%, 5%

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34
Q

A Primary Care Dr places his patient on a beta blocker 3 days before surgery as a precaution. Does this reflect current guidelines?

A

No - not recommended

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35
Q

Your patient has CHD and is undergoing an intermediate risk procedure. His indication for a 12 Lead EKG is

A

Class 1 - procedure is indicated

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36
Q

Recommendations for preoperative 12 Lead EKG

Class 1

A

Class 1 - procedure is indicated
One clinical risk factor and vascular surgery
Known CHD, peripheral artery dz or cerebrovascular dz and intermediate risk surgery

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37
Q

Recommendations for preoperative 12 Lead EKG

Class IIa

A

Class IIa - procedure is reasonable

no clinical risk factors vascular surgery

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38
Q

Recommendations for preoperative 12 Lead EKG

Class IIb

A

Class IIb - may be considered

one clinical risk factor and intermediate risk

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39
Q

Recommendations for preoperative 12 Lead EKG

Class III

A

Class III - not performed

low risk, procedure asymptomatic

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40
Q

Murmurs associated with an abnormal EKG or CXR are considered a ______ indication for an ECHO

A

Class IIa

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41
Q

Does your patient need an ECHO?

Class I

A

Class I - there is evidence and/or general agreement that an echo is useful in asymptomatic murmurs -
diastolic, continuous, late systolic, murmurs associated with ejection clicks, murmurs that radiate to the neck or back, gr 3 or louder systolic murmurs

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42
Q

Does your patient need an ECHO?

Class IIa

A

Class IIa - the weight of evidence or opinion is in favor of usefulness of an echo for murmurs associated with other abnormal physical findings, abnormal EKG or CXR

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43
Q

Does your patient need an ECHO?

Class III

A

Class III - there is evidence and/or general agreement that an ECHO is NOT useful for grade 2 or softer midsystolic murmurs considered innocent or functional

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44
Q

Evaluation of LV function

Class IIa

A 
Class IIa (reasonable to perform)
Dyspnea of unknown origin, heart failure, worsening of dyspnea if not performed in the last 12 months
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45
Q

Evaluation of LV Function

Class IIb

A

Class IIb - (may be considered)

Reassessment of LV function in pts with previously diag cardiomyopathy

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46
Q

Evaluation of LV Function

Class III

A

Class III - (No - not helpful)

routine testing

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47
Q

Evaluation of LV function for a patient diagnosed with cardiomyopathy is ____

A

Class IIb

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48
Q

What are the 3 A’s of Anesthesia?

A

Analgesia
Anesthesia
Amnesia

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49
Q

What are four things the surgeon requires?

A

Immobility, positioning, muscle relaxation, ability to post op test
pain management, go home same day, stay intubated

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50
Q

What are 4 patient concerns?

A

N/V, pain, death, paralysis, wake up crazy, being awake

51
Q

What are 4 strategies to come up with a winning plan?

A

Are you proficient in the anesthetic plan, are your patient & surgeon on board, is your CRNA/anesthesiologist on board?, back up plan, do you have everything you need to make your plan succeed?

52
Q

What are 4 things that will doom your plan to failure?

A

not knowing what you’re doing

53
Q

What are the 3 periop computer systems at Vanderbilt?

A

Vpims
VPIMSweb
Starpanel

54
Q

What is the most reliable source of info about your patient?

A

the patient

55
Q

If a preop was templated and has the physical exam filled out, is it complete?

A

NO

56
Q

What is the name of diagnosis and procedure codes in the US?

A

ICD9 or ICD10, CPT

57
Q

Which of the following is not a red flag for preops:

A

MILD pulmonary hypertension

58
Q

Red flags for preops

A

documented cardiac history with no EKG or relevant medical clearance, all pt’s with MI in last 6 mths, unstable angina, CP, stents, new EKG changes, pacemaker/AICD, OSA/hx of difficult airway/asthma, ED visit in last 2 mths, pneumonia within last 4 wks, TB with CXR or skin test s syndrome, malignant hyperthermia, lupus, history of cardiac arrest, pulm HTN, difficult IV access

59
Q

In the USA between 1999-2005, 1030 people died of anesthesia related complications to what?

A

overdose of anesthetics

60
Q

In Japan study, emergency surgery for an ASA4 patient increases the risk of anesthesia complications by what factor?

A

4 times the risk

61
Q

In Japan what was the leading cause of critical events of people with good physical status?

A

Anesthetic Management

62
Q

In Japan what was the leading cause of critical events in those with poor physical status?

A

Coexisting Disease

63
Q

In the US, mortality due to anesthesia is higher in what gender?

A

male

64
Q

A basic neuro exam should include what?

A

orientation to person/place/time/date/procedure

eyesight, pupils, visual field

65
Q

What is the fastest growing specialty in surgery?

A

Interventional Radiology

66
Q

What is Hunt & Hess?

A

Grade for Stroke

67
Q

What is the IHSS Stroke Score for?

A

30 day mortality rate for stroke

68
Q

3 IR treatments for an aneurysm are?

A

glue, coiling, clipping

69
Q

3 IR treatments for a clot are?

A

penumbra, solitaire FR, Trevo Pro

70
Q

3 drugs that dissolve clots are?

A

TPA, Reopro, Integrillin

71
Q

According to the American Cancer Society, lung cancer is the number _____ cancer in the US

A

2

72
Q

EBUS

A

endobronchial ultrasound

73
Q

Which anesthetic gas in current use is the best for a reactive airway?

A

Sevoflurane

74
Q

What are 2 possible airway effects of the asthmatic in the OR?

A

bronchospasm and laryngospasm

75
Q

What is the most feared respiratory complication in anesthesia?

A

aspiration

76
Q

What is the PCI goal for a STEMI?

A

<90 min

77
Q

What does the 1st heart sound represent?

A

closure of the mitral and tricuspid valves

78
Q

What % of non cardiac surgical pts suffer a cardiac morbidity?

A

1-5%

79
Q

What remains the Gold Standard test for cardiac function?

A

Stress test on treadmill

80
Q

What does an S3 murmur represent?

A

heart failure

81
Q

What is the most commonly encountered type of drug induced hepatitis?

A

tylenol

82
Q

What is the most common complication of cirrhosis?

A

fatigue

83
Q

What is the major course of M & M in the pt with cirrhosis?

A

bleeding from esophageal varices

84
Q

Liver disease is reflected by what lab signs?

A

increased total bilirubin, increased AST, increased ALT, decreased albumin, increased PT

85
Q

Surgical risk is greater in a liver patient with the following 5 factors…?

A

high bilirubin (>3.0 mg/dL), low albumin (<3.0 g/dL), severe ascites, coma, poor nutrition

86
Q

What 2 lab tests best evaluate liver dz?

A

serum albumin and PT

87
Q

A low albumin (half life 20 days) reflects acute or chronic liver disease?

A

chronic

88
Q

Which class of drugs should you avoid in a patient with a history of ulcers?

A

NSAIDS

89
Q

What is your primary concern with a tooth abscess?

A

airway

90
Q

What is a Whipple?

A

resection of antrum of stomach, duodenum, gallbladder, and head of pancreas

91
Q

What should you check in a patient with GI symptoms?

A

frequency, recent EGD, how many pillows, treatment and efficacy, hemoptysis

92
Q

What is a major risk factor of a patient with a bowel obstruction?

A

vomiting

93
Q

Name 4 issues with morbid obesity?

A

airway, IV access, Loss of FRC (functional residual capacity), metabolism

94
Q

How much renal function may be lost before a patient is symptomatic?

A

80%

95
Q

What is the leading cause of kidney disease in the US?

A

Diabetes

96
Q

Why are chronic renal patients anemic?

A

healthy kidneys secrete erythropoietin

anephric patients do not

97
Q

Which of the following electrolytes are affected by CRF?

A 
hyperpotassium
hypermagnesium
hyperphosphate
hypocalcium
hypernatremic
98
Q

Coagulopathy in CRF leads to what 4 sites of bleeding?

A

GI, epistaxis, subdural hematoma, hemorrhagic pericarditis

99
Q

In order to differentiate pre renal (decreased renal perfusion) from acute renal failure (tubular damage) what test might you order?

A

fractional excretion of filtered sodium

If 1% = obstructive renal failure or ATN

100
Q

What is the fastest growing endocrine disease in the US?

A

Diabetes

101
Q

What are the symptoms of thyroid storm?

A

hypermetabolic state (increased HR, BP, ect.)

102
Q

What does a pheochromocytoma secrete?

A

catecholamines (noradrenaline & epi)

103
Q

What needs replacing after a parathyroidectomy?

A

calcium

104
Q

What does MEN syndrome stand for?

A

Multi Endocrine Neoplasia

105
Q

MEN syndrome

A

a group of rare diseases caused by genetic defects that lead to hyperplasia and hyperfunction of 2 or more components of the endocrine system

106
Q

MEN type 1

A

Wermer syndrome - hyperparathyroidism, pituitary adenomas, pancreatic islet-cell tumors

107
Q

MEN type 2A

A

Sipple syndrome - Medullary thyroid cancer, hyperparathyroidism, pheochromocytoma

108
Q

MEN type 2B

A

mucosal neuroma syndrome - medullary thyroid tumor, pheochromocytoma, neuromas of the oral mucosa, marfanoid habitus (tall, thin, big hands)

109
Q

What gland is often removed in pediatric congenital heart surgery?

A

thymus

110
Q

What gland is resected through the nose?

A

pituitary

111
Q

Second most common cause of death

A

cancer

112
Q

Most common cancer in men

A

prostate

113
Q

Most common cancer in women

A

breast

114
Q

Antitumor lung toxic drug

A

Bleomycin

115
Q

Features of a child’s airway vs. adults are

A

a funnel shaped larynx

116
Q

Most common cancer in children is

A

leukemia

117
Q

It is important to discuss the risks of anesthesia in front of the children?

A

FALSE

118
Q

Oxygen consumption of an infant is ________ that of an adult

A

Twice

119
Q

Recent studies have shown that infants have _______ sensitivity to pain

A

increased

120
Q

Almost all pediatric codes are due to

A

respiratory distress

121
Q

Which of the following is a normal change of pregnancy:

A

increase in CO

122
Q

What is the most common cause of maternal mortality for the pregnant woman in the US?

A

thromboembolic event

123
Q

In the US how many pregnant women have surgery not related to delivery?

A

1-50

124
Q

Which of the following is a red flag related to pregnancy?

A

proteinuria and elevated LFTs

125
Q

According to the AANA guidelines the primary responsibility of the CRNA is toward the neonate post delivery T/F

A

FALSE

Anesthesia (7 decks)

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