Anesthesia-Biochemistry Review - Final XLS in CSV form - Sheet1 Flashcards
What is another name for Bupivicaine?
Marcaine
Which anesthetic has the shortest halflife?
Chloroprocaine
Which anesthetic has the fastest onset?
Lidocaine
Which anesthetic has a risk of CAUSING withdrawal? Why?
Stadol (Butorphanol), it’s a mixed mu-agonist antagonist
A patient has mitral stenosis, what do you give to block intubation reflex hypertension?
Nitroprusside, In patients in whom hypertension during laryngoscopy could result in hypertensive crisis or cardiac decompensation, the anesthesiologist may administer anti-hypertensives during intubation.
Findings in autonomic dysreflexia?
Hypertension, Bradycardia, Flushing
Longest lasting anesthetic for an epidural?
Bupivicaine
What is the worst complication of halothane?
Hepatotoxicity
Most common cause of mortality in setting of epidural placed for C-S?
Local toxicity
Local anesthetic epidural anesthesia is LEAST associated with
a) hypotension
b) FHR abnormalities
c) pruritis
d) spinal headache
Pruritus (that is for Narcotic epidurals, not local anesthetic)
What is the best medication to alleviate hypertension in a preeclamptic patient at time of general anesthesia induction?
Nitroglycerin, In patients in whom hypertension during laryngoscopy could result in hypertensive crisis or cardiac decompensation, the anesthesiologist may administer anti-hypertensives during intubation.
What is the principal substrate for oxidative metabolism in the placenta?
Glucose
Where are the different Prostaglandins made?
PGI2: Myometrium
PGE2: Decidua and Amnion
PGF2alpha: Decidua
Mechanism of Uterine Contraction?
phospholipase C converts phospatidylinositol triphosphate to inositol triphosphate, which release calcium from the sarcoplasmic reticulum. Calcium then binds to calmodulin; the calcium-calmodulin complex then activates myosin light chain kinase. Myosin light chain kinase phosphorylates myosin light chain, which enables the ATPase activity & causes sliding of myosin over actin fibrils.
What drug increases the motor blockade with magnesium sulfate?
Calcium Channel Blocker
What enzyme is the rate-limiting step in synthesis of prostaglandin?
Phospholipid converstion by Phospholipase A2 to Arachidonic acid
What medication causes reversible hearing loss in the fetus?
Streptomycin
Why is it a bad plan to give I131 in pregnancy?
It will destroy the fetal thyroid (because it concentrates there startingat 10-12 weeks)
Fasting levels of what causes NTD? When might you see it?
Homocysteine, With Folic Acid antagonists blocking folate acid synthesis and back up results in increased homocysteine.
Which agents can potentially cause renal anomalies along with oligohydramnios?
ACE-inhibitors (-opril drugs)
Features of Congenital Rubella?
Blueberry Muffin, Cardiac issues, Cataracts, CNS and Deafness.
Recurrence risk with spina bifida?
1.5% if one effected chlid, 7% if 2
Microtia associated with other drugs then isotretinoin?
Thalidomide, Mycophenolate
NTDs are usually:
a) Due to single gene defects
b) Caused by teratogens
c) Multifactorial
d) Aneuploidy
Multifactorial
Features of Fetal Varicella?
Mental Retardation, Limb Hypoplasia, Scarring of Skin, Eye
Maternal risk of Varicella?
30% pneumonia which has a 30% mortality.
External Genitalia differentiation stimulated by what hormone?
LH which stimulates testosterone
What is hormones are HPL most like?
Prolactin and GH
Precursor for Fetal Steroid Synthesis?
Maternal LDL
What is the structure of TRH?
Tripeptide
What is not covered by Cephalosporins?
a) Enterococcus
b) Group A Strep
c) Group B Strep
Enterococcus
What is Combivir?
Zidovudine (AZT) + Lamivudine
Treatment for HIV+ women with Viral load > 1000 near term?
Cesarean at 38 weeks, Continue ART therapy, and start AZT 3 hours prior to cesarean
What is most resistant to GBS?
a) Erythromycin
b) Clindamycin
c) Penicillin
d) Azithromycin
Erythromycin
What is not associated with intraabdominal calficiations?
CMV, Toxo, Parvo, CF, Meconium Peritonitis?
Parvovirus
What is not associated with placental thickening?
a) Syphilis
b) Rh Issoimmunization
c) Non-immune hydrops
d) Listeriosis
Listeriosis
What is used in the treatment of Lyme in pregnancy?
a) Penn
b) Doxy
c) Vancomycin
d) Clindamycin
e) Cephalosporin
Cephalosporin (Or amoxicillin)
A mother who is HIV positive who took no meds during the pregnancy what is given in labor to decrease transmission?
a) Acyclovir
b) Lamivudine
c) Nevirapine
Nevirapine (in combination with AZT or if AZT is unavailable)
Least likely associated with mental retardation?
Only 0.4% of women with varicella in first trimester have affected children.
Malaria, which more likely to have PROM(?)?
Malaria is worse in primigravid women, and also worse in areas with less malaria (i.e. because less prior exposure to it). Sickle trait provides protection against malaria. Thus I assume the correct answer is A, primip without hx of malaria.
Risk of Early onset GBS if not treated in labor and GBS positive?
1-2%
Per the CDC report, in the absence of intervention 1-2% of infants born to colonized mothers develop early-onset GBS sepsis. Prior to instituting universal screening, the incidence of GBS sepsis was 1.7/1000, now is 0.33/1000.
Which is the most sensitive test to determine whether the fetus is infected with toxo
a) amnio for toxo PCR
b) PUBS for fetal IgM
c) PUBS for fetal IgG
Amnio for toxo PCR (immature fetal immune system so less likely to make Antibodies and IgG may be moms)
What is treated with spiramycin?
Intrauterine Toxoplasmosis
Most severe manifestation In listeria is?
The main manifestation of Listeria is stillbirth.
Which of the following is LEAST associated with an enlarged placenta:
a) listeria
b) Parvo
c) NIH
d) syphilis
e) toxo
Toxoplasmosis, syphilis, and parvo can all cause non-immune hydrops, which has placentamegaly as a feature.
What is the risk of transmission in the first trimester with primary CMV infection
40%
Which organisms are most likely to cause Toxic Shock Syndrome?
Staph Aureus, Group A Strep
What is the prevalence of asymptomatic bacteriuria in pregnancy?
a) 5%
b) 15%
c) 25%
5%
How many asymptomatic bacteriuria pregnant women would develop symptomatic infection if untreated vs. treated?
20-35% compared to <4% if treated
Choose the highest risk of contracting hepatitis B.
a) Whole blood
b) Cryoprecipitate
c) Albumin
Cryoprecipitate is pooled from multiple donors, thereby increasing the risk for Hepatitis B infection.
Best treatment for Neisseria Gonorrhea in pregnancy?
Ceftriaxone
Why do we not use Rapid GBS?
Low Sensitivity
Which of the following are findings in BV?
pH>4.5
+Whiff test
Thin homogeneous discharge
>20% clue cells
What type of virus is HIV?
RNA Retrovirus
The mother has a blood type of O+ and the baby has a blood type of A+. The baby has been breast-feeding and 2 days post partum is noticed to be jaundice. The mom has no antibodies but there is a + direct Coombs. What is the most likely cause?
a) Breast Feeding
b) ABO incompatibility
c) Rh Disease
d) Immature fetal liver enzymes
ABO incompatibility
What physical finding on a baby is associated with a term birth?
Scrotal Rugae
What is the most common cause of a low apgar score in a preterm infant?
a) Prematurity
b) Acidosis
c) Sepsis
d) Chromosome abnormality
Prematurity
What is the Fetal Cardiac Output at term?
500mL/kg/min
Most likely outcome of Meconium stained fluid with normal heart tracing?
Normal
Physical Signs of fetal immaturity
Poor tone Smooth, transparent skin Sparse lanugo, fine and fuzzy scalp hair no sole creases, NOT PALMAR creases (theyre not included), lack of rugae Small breast nodules Pliable ear lobe with no cartilage No scrotal rugae (BERT Breast Nodules Ear is pliable Rugae (scrotal and soles) Tone is low)
Risk of CP with APGAR score of <=3 at 5 minutes?
What about at 15-20 minutes?
An apgar score <=3 at 5 minutes is associated with 5% risk of CP. Becomes 50% when Apgar <=3 persists at 15-20 minutes.
Surfactant treatment of a 28 week newborn will help decrease what the most?
Neonatal Mortality
Most common location of brain bleed in premature infant?
Germinal Matrix
What is the most common problem for a term IUGR infant?
Hypoglycemia
Cerebal palsy is a diseas of what part of the nervous cystem?
upper motor neuron disease due to damage of white matter.
Which drug can cause neonatal hypotermia?
Valium
What are the most common causes of maternal mortality?
#1 Cardio #2 Infection #3 Hemorrhage
Treatment for IHSS?
Beta blocker (propranolol), controls the heart rate so more time for ventricular filling
Algorithm for managing SVT?
#1) Vagal maneuvers (holding breath, valsalva) #2) Carotid Massage #3) Adenosine #4) Verapamil #5) Beta blocker
Which hepatitis can cause chronic active hepatitis and cirrhosis?
Hep C
What cardiac lesions should be deliverd by cesarean?
Dilated Aortic Root >40mm Aortic Aneurysm Recent MI Acute Severe CHF Severe Symptomatic AS
Who should receive prophylaxis for endocarditis?
Previous infective endocarditis
Unrepaired Cyanotic defect
Defects repaired with prosthetic material (first 6 months)
Defects reapired with prosthetic material with residual defect at repair site
Infection and a prosthetic valve
Medications for SBE prevention?
Ampicillin or Cephalosporin
Which parameters are directly measured by Swan?
HR CVP Pulmonary artery systolic and diastolic pressure PCWP Cardiac output
What does PCWP approximate/indicate?
LV preload / filling
What does CVP approximate/indicate?
RV Preload / filling
What dictates delivery mode in patients with ITP?
Obstetrical reasons
Postpartum thyroiditis has all the following symptoms except? Depression Tachycardia HTN Diarrhea
HTN is not
Symptoms of the hyperthyroid phase include heat intolerance, fatigue, palpitations, nervousness and diarrhea. HTN is not a component of this. Hypothyroid phase is marked by depression, cold intolerance, hair loss, fatigue, dry skin, impaired concentration.
Which is the thrombophilia with the worst prognosis?
Antithrombin III
Which thombophilia is the most common?
Factor V leiden
What is the most appropriate to give a patient for long-term anticoagulation and breast-feeding?
a) LMWH
b) Full dose heparin
c) Coumadin
d) Mini-heparin
e) ASA
Coumadin is the most appropriate medication for long-term anticoagulation and is compatible with breastfeeding.
What is least useful with SC disease?
a) FeSO4
b) Folic acid
c) Pneumovax
d) Antibiotics for suppression
FeSO4, can lead to hemochromatosis if patient is not iron deficient
A mother has diabetes, which is the least likely complication to the fetus?
a) Hypoglycemia
b) Hypocalcemia
c) Hypothermia
d) Polycythemia
Hypothermia does not
What is associated with graft versus host?
Erythema multiforme
Multiple Sclerosis is most associated with which pregnancy complication?
IUGR (MS = Mighty Small)
What dose of folic acid do patients with sickle cell require?
4mg
Most likely antibody to result from transfusion?
a) D
b) C
c) E
d) Kell
e) N
Kell
Name 3 diseases that can be treated with IVIG?
IVIG is a proven treatment for myasthenia, NAIT, and ITP.
Most common complication of neontatal thrombocytopenia?
Rash more than thrombocytopenia
Which is likely to present for the first time during pregnancy?
a) Hg SC disease
b) Hg S-thal
c) Hg SS
Hb SC disease
Most common non cardiac cause of maternal mortality
Embolism
Which infection is a transplant patient least susceptible to compared with non-transplant patients?
E. coli, CMV, Chlamydia?
Chlamydia
What are good prognosis findings in fetal urine?
Sodium (Na) Less than 100 mEq per liter
Chloride (Cl) Less than 90 mEq per liter
Osmolarity (Osm) Less than 210 mEq per liter
Calcium (Ca) Less than 2 mmol per liter
Beta-2 microglobulin Less than 2 mg per liter
Most common complication with insulin pump?
Site infection, asymptomatic hypoglycemia
These drugs should not be used in patients with myasthenia gravis except:
a) Curare
b) Magnesium
c) Gentamicin
d) Mestinon
Mestinon (used to treat Myasthenia gravis)
Aldomet Mode of action?
Central alpha blocker
Minipres mode of action?
Alpha blocker
Atenolol mode of action?
Beta blocker
Lasix mode of action?
Loop diuretic
Diazoxide mode of action?
Thiazide analog (non-diuretic, vasodilator)
Marfan Aortic root recommendations?
Recommend beta blockers, cesarean delivery for aortic root >5. Recommend repair prior to pregnancy for aortic root >4
Mutation in Sickle Cell?
can detect valine to glutamine at 6 position of beta chain on chromosome 11
Which is the bad malaria in pregnancy?
Falciparum
Which of these is a more common surgical complication of c hyst? Ureteral injury Cystotomy Fistula Bowel Injury
Cystotomy
False positives for KB?
Anything that can be caused by anything that causes maternal HbF to be elevated – beta thal, sickle cell
What effeect will glucose have on BPP?
Increased Breathing (not movement)
What is increased in the fasting state in pregnancy?
Cholesterol, depends on this for energy NOT gluconeogenesis
Which cell is not part of innate immunity?
Monocyte
At term which fetal organs get the most blood flow?
#1 Placenta #2 Brain #3 Lungs
Which Swan values are calculated?
MAP, SV, SVR, PVR, LVSW
Swan readings for Hemorrhage?
Decrease: CO, PCWP and CVP
Increase: SVR
Swan readings for pulmonary edema?
Increase: PCWP > 18, CVP
Swan readings for septic shock?
Decrease: SVR
Increase: Co
Swan readings for PE?
Increase: Pulmonary artery pressure
Weight of the uterus at term? Non pregnant?
The uterus weighs 1100-1200 g at term. Non-pregnancy <100g.
What is gap junction protein?
Connexin
Which chromosome is oxytocin receptor on?
3
When does Relaxin peak?
8-12 weeks
NO reacts with what to produce cGMP?
Iron
Which enzymes catalyzes the degradation of endothelin-1?
Enkephalinase
Which of the following is not a uterotonin?
a) Endothelin-1
b) Prostaglandins
c) Oxytocin
d) Calcium
Calcium , its needed for contractions, but isnt a factor that causes them like Endothelin, PG and Oxytocin
Where is PGE2 produced mostly?
Amnion
Where is PGF2apha produced mainly?
Decidua
What enzyme causes prostaglandin inactivation? Where is it found?
Prostaglandin Dehydrogenase, Chorion
Which of the following is the action of platelet activating factor on myometrial cells?
Increases intracellular Calcium
Which IL is a regular component of amniotic fluid?
IL8
GnRH is made in which tissue?
Cytotrophoblast and Decidua
Action of PGI2
Prostacyclin is a potent vasodilator. It is produced in endothelial cells & the myometrium. It is also a uterine relaxing agent.
What vitamin must you supplement in vegans?
B12
Which R-A-S component increases and then decreases?
Renin peaks at 12 weeks then declines in 3rd trimester
Facial nerve palsy is a complication of which Operative delivery method?
Forceps
What percentage of Rh negative patients who do not receive Rhogam will be sensitized?
15%
In preeclampsia what happens to thromboxane and PGI2?
Thromboxane increases (normally it stsays the same) and PGI2 Decreases (normally it increases)
Which part of the Choirion is avascular?
Chorion Laeve
Which has lowest chance of MR in child? a) accutane in first trimester b) Rubella exposure first trimester c) varicella exposure first tri d) warfarin first trimester
VARICELLA TRANSMISSION IN FIRST TRIMESTER IS RARE!
