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ABOMS (Johnston) > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

Max dose of epinephrine non-cardiac / cardiac

A

.2mg / 0.04mg

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2
Q

Sulfa allergy has greater incidence to which class of local anesthetic

A

Esters

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3
Q

Max dose 2% lidocaine

A

4.4mg/kg or 300mg

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4
Q

Max dose 4% articaine

A

1.3mg/kg or 90mg

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5
Q

How many mg of 1% anesthetic in 1.7ml

A

17mg

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6
Q

How many mg of epi in 1:100,000 1.7ml

A

0.02mg

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7
Q

Which vasocontrictor additive in LA has alpha agonism resulting in increased MAP and reflex braycardia (good for tachycardic patients)

A

Levonordefrin

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8
Q

Which vasocontrictor additive in LA has beta agonism and is better for hypertensive patients

A

Epinephrine

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9
Q

NPO time for breast milk

A

4hrs

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10
Q

Role and mechanism of Train of Four

A
  • Depolarizing –> uniform decrease in twitch amplitude in TOF - Non depolarizing –> sum of twitches based on % of receptors occupied. 1 twitch 95%, 2 twitches 85%, 3 twitches 80%, 4 twitches 75% makes sense because minimum 25% available receptors for NMJ function
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11
Q

Role and mechanism of Tetanic nerve stimulator

A

Depolarizing –> no fade in muscle response with tetany (if there is fade then there has been prolonged exposure to succinylcholine or phase 2 blockade) - Non depolarizing –> fade with tetany

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12
Q

Why is Sp02 falsely elevated in CO poisoning and heavy smokers?

A

CO poisoning and heavy smokers have increased carboxyhemoglobin which falsely elevates SpO2

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13
Q

Which leads most sensitive to ST elevation

A

Lead II Lead V5

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14
Q

Which volatile agent has airway irritation

A

Desflurane

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15
Q

Which volatile agent has slow onset

A

Isoflurane

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16
Q

While volatile agent may be contraindicated in renal patient?

A

Sevoflurane (compound A)

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17
Q

What hemodynamic effects do all volatile agents have

A

hypotension tachycardia decreased contractility decreased systemic vascular resistance

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18
Q

What ventilation effects do volatile agents have? (Exception-Isoflurane)

A

Tachypnea Hypercapnea Decreased Tv Decreased minute ventilation

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19
Q

Mechanism of Miosis with opioid

A

CN III parasympathetic agonist

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20
Q

Site of propofol metabolism

A

liver

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21
Q

All IV sedation agents decrease cerebral blood flow and ICP except

A

Ketamine

22
Q

Mechanism of neostigmine

A

Build up of ACh within NMJ. It is an acetyl cholinesterase inhibitor

23
Q

Dose of neostigmine

A

0.03-0.07 mg/kg

24
Q

Contraindications of Succinylcholine

A

Recent burn/crush injury NMJ disease Narrow angle glaucoma Malignant hyperthermia Skeletal muscle myopathies

25
Q

Which two neuromuscular blocking agents are best for renal or hepatic failure patients

A

Atracurium Cisatracurium (Hoffman Elimination)

26
Q

s/s cocaine intoxication

A

HTN, Tachy, hallucinations, convulsions, HA, Angina, CVA

27
Q

Tx cocaine intoxication

A

B-blockers Nitrates CCB

28
Q

Cocaine half-life

A

30-90 mins

29
Q

Main difference between cocaine detox and EtOH detox

A

EtOH detox also has HTN/Tachycardia

30
Q

Age/gender most common for thyroid storm

A

Women 20-40 yrs

31
Q

Most common cause underlying condition in thyroid storm

A

recently diagnosed/undiagnosed Grave’s disease with trauma/surgical stress

32
Q

s/s thyroid storm

A

HTN, Tachy, MI, dysrhythmias, Hyperthermia

33
Q

Main difference in s/s between thyroid storm and MH

A

MH also has acidosis

34
Q

Emergent tx of thyroid storm

A

Propranolol

35
Q

What medications can be given 6-8 weeks prior to elective surgery in patient with recently diagnosed Grave’s Disease

A

Propylthiouracil Prevents conversion of T4 to T3, inhibits thyroid hormone stimulation

36
Q

How many mins reserve O2 does obese person have?

A

2mins

37
Q

What common maneuver worsens air trapping in bronchospasm?

A

PEEP It can cause lung hyperinflation.

38
Q

Pathophysiology of MH

A

Calcium dump from sarcoplasmic reticulum in skeletal muscle

39
Q

Early signs of MH

A

Hypercarbia Tachy Tetany

40
Q

Late signs of MH

A

Hyperkalemia with ECG changes Rhabdo Hyperthermia

41
Q

Most common causes of death in MH

A

Hypercoagulation 2/2 hyperthermia Hyperkalemia

42
Q

Loading dose of dantrolene for MH

A

2.5mg/kg

43
Q

s/s myasthenic crisis vs cholinergic crisis

A

SAME signs/symptoms Weakness, bronchospasm, diaphoresis, cyanosis

44
Q

Myasthenic crisis vs cholinergic crisis

A

Myasthenic crisis = insufficient medication Cholinergic crisis = excess medication

45
Q

Most common myasthenia gravis medication and its duration of effect

A

Pyridostigmine = Anti-Acetylcholinesterase 3-6 hour duration

46
Q

Which volatile agents are potent bronchodilators

A

Isoflurane Enflurane

47
Q

Which paralytics cause histamine release and are contraindicated in asthmatic

A

Atracurium Mivacurium

48
Q

Classification of cerebral palsy

A

Spastic (motor cortex, 75% of CP patients) Dyskinetic (basal ganglia) Ataxic (cerebellum)

49
Q

Periop management of CP

A

Volatile induction (IV access hard with contractures) Aspiration precautions (decreased tone + hypersalivation) Avoid Succinylcholine Increase MAC and non-depolorizing dose Lowered seizure threshold Chronic hypovolemia with pre-renal kidney injury/failure

50
Q

What LA agents can cause methemoglobinemia at high doses?

A

Prilocaine

ABOMS (Johnston) (8 decks)

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