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JFNG > Anesthesia-Biochemistry Review - Final XLS in CSV form - Sheet1 > Flashcards

Anesthesia-Biochemistry Review - Final XLS in CSV form - Sheet1 Flashcards

1
Q

What is another name for Bupivicaine?

A

Marcaine

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2
Q

Which anesthetic has the shortest halflife?

A

Chloroprocaine

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3
Q

Which anesthetic has the fastest onset?

A

Lidocaine

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4
Q

Which anesthetic has a risk of CAUSING withdrawal? Why?

A

Stadol (Butorphanol), it’s a mixed mu-agonist antagonist

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5
Q

A patient has mitral stenosis, what do you give to block intubation reflex hypertension?

A

Nitroprusside, In patients in whom hypertension during laryngoscopy could result in hypertensive crisis or cardiac decompensation, the anesthesiologist may administer anti-hypertensives during intubation.

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6
Q

Findings in autonomic dysreflexia?

A

Hypertension, Bradycardia, Flushing

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7
Q

Longest lasting anesthetic for an epidural?

A

Bupivicaine

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8
Q

What is the worst complication of halothane?

A

Hepatotoxicity

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9
Q

Most common cause of mortality in setting of epidural placed for C-S?

A

Local toxicity

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10
Q

Local anesthetic epidural anesthesia is LEAST associated with

a) hypotension
b) FHR abnormalities
c) pruritis
d) spinal headache

A

Pruritus (that is for Narcotic epidurals, not local anesthetic)

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11
Q

What is the best medication to alleviate hypertension in a preeclamptic patient at time of general anesthesia induction?

A

Nitroglycerin, In patients in whom hypertension during laryngoscopy could result in hypertensive crisis or cardiac decompensation, the anesthesiologist may administer anti-hypertensives during intubation.

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12
Q

What is the principal substrate for oxidative metabolism in the placenta?

A

Glucose

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13
Q

Where are the different Prostaglandins made?

A

PGI2: Myometrium
PGE2: Decidua and Amnion
PGF2alpha: Decidua

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14
Q

Mechanism of Uterine Contraction?

A

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.

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15
Q

What drug increases the motor blockade with magnesium sulfate?

A

Calcium Channel Blocker

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16
Q

What enzyme is the rate-limiting step in synthesis of prostaglandin?

A

Phospholipid converstion by Phospholipase A2 to Arachidonic acid

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17
Q

What medication causes reversible hearing loss in the fetus?

A

Streptomycin

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18
Q

Why is it a bad plan to give I131 in pregnancy?

A

It will destroy the fetal thyroid (because it concentrates there startingat 10-12 weeks)

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19
Q

Fasting levels of what causes NTD? When might you see it?

A

Homocysteine, With Folic Acid antagonists blocking folate acid synthesis and back up results in increased homocysteine.

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20
Q

Which agents can potentially cause renal anomalies along with oligohydramnios?

A

ACE-inhibitors (-opril drugs)

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21
Q

Features of Congenital Rubella?

A

Blueberry Muffin, Cardiac issues, Cataracts, CNS and Deafness.

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22
Q

Recurrence risk with spina bifida?

A

1.5% if one effected chlid, 7% if 2

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23
Q

Microtia associated with other drugs then isotretinoin?

A

Thalidomide, Mycophenolate

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24
Q

NTDs are usually:

a) Due to single gene defects
b) Caused by teratogens
c) Multifactorial
d) Aneuploidy

A

Multifactorial

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25
Q

Features of Fetal Varicella?

A

Mental Retardation, Limb Hypoplasia, Scarring of Skin, Eye

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26
Q

Maternal risk of Varicella?

A

30% pneumonia which has a 30% mortality.

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27
Q

External Genitalia differentiation stimulated by what hormone?

A

LH which stimulates testosterone

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28
Q

What is hormones are HPL most like?

A

Prolactin and GH

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29
Q

Precursor for Fetal Steroid Synthesis?

A

Maternal LDL

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30
Q

What is the structure of TRH?

A

Tripeptide

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31
Q

What is not covered by Cephalosporins?

a) Enterococcus
b) Group A Strep
c) Group B Strep

A

Enterococcus

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32
Q

What is Combivir?

A

Zidovudine (AZT) + Lamivudine

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33
Q

Treatment for HIV+ women with Viral load > 1000 near term?

A

Cesarean at 38 weeks, Continue ART therapy, and start AZT 3 hours prior to cesarean

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34
Q

What is most resistant to GBS?

a) Erythromycin
b) Clindamycin
c) Penicillin
d) Azithromycin

A

Erythromycin

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35
Q

What is not associated with intraabdominal calficiations?

CMV, Toxo, Parvo, CF, Meconium Peritonitis?

A

Parvovirus

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36
Q

What is not associated with placental thickening?

a) Syphilis
b) Rh Issoimmunization
c) Non-immune hydrops
d) Listeriosis

A

Listeriosis

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37
Q

What is used in the treatment of Lyme in pregnancy?

a) Penn
b) Doxy
c) Vancomycin
d) Clindamycin
e) Cephalosporin

A

Cephalosporin (Or amoxicillin)

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38
Q

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

A

Nevirapine (in combination with AZT or if AZT is unavailable)

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39
Q

Least likely associated with mental retardation?

A

Only 0.4% of women with varicella in first trimester have affected children.

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40
Q

Malaria, which more likely to have PROM(?)?

A

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.

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41
Q

Risk of Early onset GBS if not treated in labor and GBS positive?

A

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.

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42
Q

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

A

Amnio for toxo PCR (immature fetal immune system so less likely to make Antibodies and IgG may be moms)

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43
Q

What is treated with spiramycin?

A

Intrauterine Toxoplasmosis

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44
Q

Most severe manifestation In listeria is?

A

The main manifestation of Listeria is stillbirth.

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45
Q

Which of the following is LEAST associated with an enlarged placenta:

a) listeria
b) Parvo
c) NIH
d) syphilis
e) toxo

A

Toxoplasmosis, syphilis, and parvo can all cause non-immune hydrops, which has placentamegaly as a feature.

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46
Q

What is the risk of transmission in the first trimester with primary CMV infection

A

40%

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47
Q

Which organisms are most likely to cause Toxic Shock Syndrome?

A

Staph Aureus, Group A Strep

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48
Q

What is the prevalence of asymptomatic bacteriuria in pregnancy?

a) 5%
b) 15%
c) 25%

A

5%

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49
Q

How many asymptomatic bacteriuria pregnant women would develop symptomatic infection if untreated vs. treated?

A

20-35% compared to <4% if treated

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50
Q

Choose the highest risk of contracting hepatitis B.

a) Whole blood
b) Cryoprecipitate
c) Albumin

A

Cryoprecipitate is pooled from multiple donors, thereby increasing the risk for Hepatitis B infection.

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51
Q

Best treatment for Neisseria Gonorrhea in pregnancy?

A

Ceftriaxone

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52
Q

Why do we not use Rapid GBS?

A

Low Sensitivity

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53
Q

Which of the following are findings in BV?

A

pH>4.5
+Whiff test
Thin homogeneous discharge
>20% clue cells

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54
Q

What type of virus is HIV?

A

RNA Retrovirus

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55
Q

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

A

ABO incompatibility

56
Q

What physical finding on a baby is associated with a term birth?

A

Scrotal Rugae

57
Q

What is the most common cause of a low apgar score in a preterm infant?

a) Prematurity
b) Acidosis
c) Sepsis
d) Chromosome abnormality

A

Prematurity

58
Q

What is the Fetal Cardiac Output at term?

A

500mL/kg/min

59
Q

Most likely outcome of Meconium stained fluid with normal heart tracing?

A

Normal

60
Q

Physical Signs of fetal immaturity

A 
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)
61
Q

Risk of CP with APGAR score of <=3 at 5 minutes?

What about at 15-20 minutes?

A

An apgar score <=3 at 5 minutes is associated with 5% risk of CP. Becomes 50% when Apgar <=3 persists at 15-20 minutes.

62
Q

Surfactant treatment of a 28 week newborn will help decrease what the most?

A

Neonatal Mortality

63
Q

Most common location of brain bleed in premature infant?

A

Germinal Matrix

64
Q

What is the most common problem for a term IUGR infant?

A

Hypoglycemia

65
Q

Cerebal palsy is a diseas of what part of the nervous cystem?

A

upper motor neuron disease due to damage of white matter.

66
Q

Which drug can cause neonatal hypotermia?

A

Valium

67
Q

What are the most common causes of maternal mortality?

A 
#1 Cardio
 #2 Infection
 #3 Hemorrhage
68
Q

Treatment for IHSS?

A

Beta blocker (propranolol), controls the heart rate so more time for ventricular filling

69
Q

Algorithm for managing SVT?

A 
#1) Vagal maneuvers (holding breath, valsalva)
 #2) Carotid Massage
 #3) Adenosine
 #4) Verapamil
 #5) Beta blocker
70
Q

Which hepatitis can cause chronic active hepatitis and cirrhosis?

A

Hep C

71
Q

What cardiac lesions should be deliverd by cesarean?

A 
Dilated Aortic Root >40mm
 Aortic Aneurysm
 Recent MI
 Acute Severe CHF
 Severe Symptomatic AS
72
Q

Who should receive prophylaxis for endocarditis?

A

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

73
Q

Medications for SBE prevention?

A

Ampicillin or Cephalosporin

74
Q

Which parameters are directly measured by Swan?

A 
HR
 CVP
 Pulmonary artery systolic and diastolic pressure
 PCWP
 Cardiac output
75
Q

What does PCWP approximate/indicate?

A

LV preload / filling

76
Q

What does CVP approximate/indicate?

A

RV Preload / filling

77
Q

What dictates delivery mode in patients with ITP?

A

Obstetrical reasons

78
Q 
Postpartum thyroiditis has all the following symptoms except? 
 Depression 
 Tachycardia 
 HTN 
 Diarrhea
A

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.

79
Q

Which is the thrombophilia with the worst prognosis?

A

Antithrombin III

80
Q

Which thombophilia is the most common?

A

Factor V leiden

81
Q

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

A

Coumadin is the most appropriate medication for long-term anticoagulation and is compatible with breastfeeding.

82
Q

What is least useful with SC disease?

a) FeSO4
b) Folic acid
c) Pneumovax
d) Antibiotics for suppression

A

FeSO4, can lead to hemochromatosis if patient is not iron deficient

83
Q

A mother has diabetes, which is the least likely complication to the fetus?

a) Hypoglycemia
b) Hypocalcemia
c) Hypothermia
d) Polycythemia

A

Hypothermia does not

84
Q

What is associated with graft versus host?

A

Erythema multiforme

85
Q

Multiple Sclerosis is most associated with which pregnancy complication?

A

IUGR (MS = Mighty Small)

86
Q

What dose of folic acid do patients with sickle cell require?

A

4mg

87
Q

Most likely antibody to result from transfusion?

a) D
b) C
c) E
d) Kell
e) N

A

Kell

88
Q

Name 3 diseases that can be treated with IVIG?

A

IVIG is a proven treatment for myasthenia, NAIT, and ITP.

89
Q

Most common complication of neontatal thrombocytopenia?

A

Rash more than thrombocytopenia

90
Q

Which is likely to present for the first time during pregnancy?

a) Hg SC disease
b) Hg S-thal
c) Hg SS

A

Hb SC disease

91
Q

Most common non cardiac cause of maternal mortality

A

Embolism

92
Q

Which infection is a transplant patient least susceptible to compared with non-transplant patients?
E. coli, CMV, Chlamydia?

A

Chlamydia

93
Q

What are good prognosis findings in fetal urine?

A

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

94
Q

Most common complication with insulin pump?

A

Site infection, asymptomatic hypoglycemia

95
Q

These drugs should not be used in patients with myasthenia gravis except:

a) Curare
b) Magnesium
c) Gentamicin
d) Mestinon

A

Mestinon (used to treat Myasthenia gravis)

96
Q

Aldomet Mode of action?

A

Central alpha blocker

97
Q

Minipres mode of action?

A

Alpha blocker

98
Q

Atenolol mode of action?

A

Beta blocker

99
Q

Lasix mode of action?

A

Loop diuretic

100
Q

Diazoxide mode of action?

A

Thiazide analog (non-diuretic, vasodilator)

101
Q

Marfan Aortic root recommendations?

A

Recommend beta blockers, cesarean delivery for aortic root >5. Recommend repair prior to pregnancy for aortic root >4

102
Q

Mutation in Sickle Cell?

A

can detect valine to glutamine at 6 position of beta chain on chromosome 11

103
Q

Which is the bad malaria in pregnancy?

A

Falciparum

104
Q 
Which of these is a more common surgical complication of c hyst?
 Ureteral injury
 Cystotomy
 Fistula
 Bowel Injury
A

Cystotomy

105
Q

False positives for KB?

A

Anything that can be caused by anything that causes maternal HbF to be elevated – beta thal, sickle cell

106
Q

What effeect will glucose have on BPP?

A

Increased Breathing (not movement)

107
Q

What is increased in the fasting state in pregnancy?

A

Cholesterol, depends on this for energy NOT gluconeogenesis

108
Q

Which cell is not part of innate immunity?

A

Monocyte

109
Q

At term which fetal organs get the most blood flow?

A 
#1 Placenta
 #2 Brain
 #3 Lungs
110
Q

Which Swan values are calculated?

A

MAP, SV, SVR, PVR, LVSW

111
Q

Swan readings for Hemorrhage?

A

Decrease: CO, PCWP and CVP

Increase: SVR

112
Q

Swan readings for pulmonary edema?

A

Increase: PCWP > 18, CVP

113
Q

Swan readings for septic shock?

A

Decrease: SVR

Increase: Co

114
Q

Swan readings for PE?

A

Increase: Pulmonary artery pressure

115
Q

Weight of the uterus at term? Non pregnant?

A

The uterus weighs 1100-1200 g at term. Non-pregnancy <100g.

116
Q

What is gap junction protein?

A

Connexin

117
Q

Which chromosome is oxytocin receptor on?

A

3

118
Q

When does Relaxin peak?

A

8-12 weeks

119
Q

NO reacts with what to produce cGMP?

A

Iron

120
Q

Which enzymes catalyzes the degradation of endothelin-1?

A

Enkephalinase

121
Q

Which of the following is not a uterotonin?

a) Endothelin-1
b) Prostaglandins
c) Oxytocin
d) Calcium

A

Calcium , its needed for contractions, but isnt a factor that causes them like Endothelin, PG and Oxytocin

122
Q

Where is PGE2 produced mostly?

A

Amnion

123
Q

Where is PGF2apha produced mainly?

A

Decidua

124
Q

What enzyme causes prostaglandin inactivation? Where is it found?

A

Prostaglandin Dehydrogenase, Chorion

125
Q

Which of the following is the action of platelet activating factor on myometrial cells?

A

Increases intracellular Calcium

126
Q

Which IL is a regular component of amniotic fluid?

A

IL8

127
Q

GnRH is made in which tissue?

A

Cytotrophoblast and Decidua

128
Q

Action of PGI2

A

Prostacyclin is a potent vasodilator. It is produced in endothelial cells & the myometrium. It is also a uterine relaxing agent.

129
Q

What vitamin must you supplement in vegans?

A

B12

130
Q

Which R-A-S component increases and then decreases?

A

Renin peaks at 12 weeks then declines in 3rd trimester

131
Q

Facial nerve palsy is a complication of which Operative delivery method?

A

Forceps

132
Q

What percentage of Rh negative patients who do not receive Rhogam will be sensitized?

A

15%

133
Q

In preeclampsia what happens to thromboxane and PGI2?

A

Thromboxane increases (normally it stsays the same) and PGI2 Decreases (normally it increases)

134
Q

Which part of the Choirion is avascular?

A

Chorion Laeve

135
Q

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

A

VARICELLA TRANSMISSION IN FIRST TRIMESTER IS RARE!

JFNG (9 decks)

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