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Anesthesia Sciences Flashcards

1
Q

Ismo

[indication]

A

vasodilator for angina

(nitrate)

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2
Q

Olopatadine

(pataday)

[indication]

A

occular itching

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3
Q

Varenicline

(chantix)

[indication]

A

nicotine addiction

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4
Q

“5 H’s” of cardiac arrest

A
  • hypovolemia
  • hypoxemia
  • Hypo- or hyperthermia
  • H+ (acidosis)
  • hypo- or hyperkalemia
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5
Q

“5 T’s” of cardiac arrest

A
  • tension pneumothorax
  • thrombosis (coronary)
  • thrombosis (pulmonary)
  • toxins
  • tamponade
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6
Q

dose of vasopressin in asystole

A

40 units

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7
Q

adequate CPR should have an EtCO2 > ____ mmHg and an a-line diastolic > ____ mmHg

A

EtCO2 > 10 mmHg

and

A-line diastolic > 20 mmHg

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8
Q

dose of Atropine for bradycardia

A

0.5 - 1 mg

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9
Q

Dopamine infusion for Bradycardia

A

2 - 20 ug/kg/min

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10
Q

signs of unstable V-tach

A

systolic blood pressure < 80

“low” for patient

rapid BP decrease

acute ischemia

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11
Q

When should Adenosine be given in SVT?

A

narrow and regular

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12
Q

Treatment for Narrow and Irregular SVT

A

beta blocker or CCB

or

Amiodarone 150 mg

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13
Q

Treatment for Wide and Regular SVT

A

amiodarone 150 mg

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14
Q

Treatment for V-fib

A

defibrillate at 200 Joules

resume CPR

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15
Q

Treatment for Torsades

A

2mg Magnesium Sulfate

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16
Q

differential diagnosis of Amniotic Fluid Embolism

A
  • eclampsia
  • hemorrhage
  • aspiration
  • anaphylaxis
  • embolism
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17
Q

Signs of Amniotic Fluid Embolism

A
  • respiratory distress
  • coagulopathy +/- DIC
  • seizure
  • altered mental status
  • unexplained fetal compromise
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18
Q

Signs of Anaphylaxis

A
  • hypoxemia
  • rash/hives
  • hypotension
  • tachycardia
  • bronchospasm
  • angioedema
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19
Q

differential diagnosis of Anaphylaxis

A
  • pulmonary embolus
  • myocardial infarction
  • anesthetic overdose
  • pneumothorax
  • aspiration
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20
Q

Treatment for Anaphylaxis

A
  • fluid bolus
  • Epi in 10-100 ug doses
  • vasopressin 2-4 units
  • H-1 antagonists (diphenhydramine)
  • H-2 antagonist
  • corticosteroids
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21
Q

what do you give to decrease biphasic response in anaphylaxis?

A

corticosteroids

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22
Q

signs of Bronchospasm

A
  • increased peak airway pressures
  • wheezing
  • increased expiratory time
  • increased EtCO2 with upsloping waveform
  • decreased tidal volumes if on PCV
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23
Q

“other” treatment options for bronchospasm

A
  • ketamine 0.2-1 mg/kg
  • hydrocortisone 100mg
  • nebulized racemic epi
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24
Q

Opioid reversal

A

naloxone 40 uq

(repeat every 2 minutes up to 400 uq)

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25
benzodiazepine reversal
flumazenil 0.2 mg | (repeat every minute up to 1mg)
26
Scopolomine reversal
Physostigmine 1 mg
27
Immediate actions of Airway Fire
stop all gas flow * re-establish ventilation * reintubate Surgeon will remove ETT and pour saline into airway
28
equation for estimated blood loss
EBV x (HCTstart - HCTmeasured) / HCTstart
29
differential diagnosis for Hypotension
* hemorrhage * anesthetic overdose * auto-PEEP * anaphylaxis * MI * pneumoperitoneum * IVC compression
30
Pneumoperitoneum
gas in the peritoneal cavity
31
4 factors in determining hypotension
decreased preload low SVR decreased contractility low HR
32
Signs of Local Anesthetic Toxicity
* tinnitus or metallic taste * altered mental status * seizures * hypotension * bradycardia * ventricular arrhythmias * cardiovascular collapse
33
Treatment for Local Anesthetic Toxicity
1.5 mL/kg bolus of 20% intralipid then 0.25 mL/kg/min infusion
34
what should you avoid in local anesthetic toxicity?
vasopressin, CCB, BB, and local anesthetics
35
early signs of Malignant Hyperthermia
* increased EtCO2 * tachycardia * tachypnea * mixed acidosis (ABG) * masseter spasm * sudden cardiac arrest due to hyperkalemia
36
later signs of malignant hyperthermia
* hyperthermia * muscle ridigity * myoglobinuria * arrhythmias * cardiac arrest
37
differential diagnosis of Malignant Hyperthermia
* light anesthesia * hypoventilation * insufflation of CO2 * hypoxemia * thyroid storm * pheochromocytoma * neuroleptic malignant syndrome (NMS)
38
dose of Dantrolene
2.5 mg/kg
39
what else should be given with dantrolene in MH?
sodium bicarb 1-2 mEq/kg
40
MHAUS
Malignant Hyperthermia Association of the US
41
Signs of Pneumothorax
* increased peak inspiratory pressures * tachycardia * hypotension * hypoxemia * decreased breath sounds * hyperresonance to chest percussion * tracheal deviation * increased JVD/CVP
42
treatment for Pneumothorax
14 or 16 gauge needle in mid-clavicular line 2nd intercostal space
43
color of 14 Gauge catheter
orange
44
color of 16 Gauge catheter
Grey
45
color of 18 Gauge catheter
Green
46
color of 20 Gauge catheter
pink
47
color of 22 Gauge catheter
blue
48
color of 24 Gauge catheter
yellow
49
Signs of Total Spinal Anesthesia
* unexpected rapid rise in senosry block * numbess in upper extremities * dyspnea * bradycardia * hypotension * loss of consciousness * apnea * cardiac arrest
50
Signs of a Hemolytic Transfusion Reaction
* tachycardia * tachypnea * hypotension * DIC * dark urine
51
Signs of Venous Air Embolus
* air on TEE or change in doppler tone * decrease * ETCO2 * BP * SPO2 * rise in CVP * respiratory distress or cough
52
Treatment for Air Embolus
* 100% O2 * flood surgical field * surgical site below heart * aspirate air from central line
53
Patients with chronic liver dysfunction and cirrhosis have a ______ circulation with ______ PVR and ____ cardiac index
hyperdynamic circulation low peripheral vascular resistance increased cardiac index
54
most common indication for liver transplantation
chronic hepatocellular disease ## Footnote due to alcohol and/or hepatitis (mostly C)
55
Preanhepatic phase of liver transplantation
complete hepatectomy
56
Anhepatic phase of liver transplant
vascular anastomoses between the donor liver and recipient's vessels
57
neohepatic phase of liver transplant
hepatic artery and biliary anastomoses are constructed
58
(2) common techniques for liver transplantation
en-block and piggyback
59
(2) patient classifications for liver disease
Child-Pugh Classification and Model for End-Stage Liver Disease (MELD)
60
Model for End-Stage Liver Disease
measures creatinine, bilirubin, INR
61
Hematologic co-morbidities in Liver Disease
* anemia * thrombocytopenia * prolonged PT and PTT * decreased plasma fibrinogen * DIC
62
potential post-operative complications of liver transplant
* massive transfusion related * anastomotic leaks * central pontine myelinolysis
63
Most common cause of death in transplant recipients
infection
64
major indications of kidney transplant
* diabetes * hypertension induced nephropathy * glomerulonephritis * polycystic kidney disease
65
CVP during kidney transplant
10 - 15 mmHg
66
50% of post kidney transplant deaths are \_\_\_\_\_
cardiac related ## Footnote detection of coronary artery disease in patients prior to transplantation is vital
67
goal systolic blood pressure during renal transplant
130-140 mmHg
68
UNOS
United Network for Organ Sharing
69
wood units
measures pulmonary vascular resistance * must have less than 6 wood units for cardiac transplant
70
What should be given prior to unclamping and reperfusion of new heart?
corticosteroids
71
target heart rate after bypass
90 - 110 bpm
72
TIPS
Transjugular Intrahepatic Portosystemic Shunt
73
Prerenal Azotemia
normal physiological response to decreased renal perfusion that leads to a reduction in GFR * accounts for 70% of hospital-aquired ARF
74
Nephritic vs Nephrotric
**Nephritic**: inadequate glomerular filtration **Nephrotic**: excessive filtration
75
Azotemia
acculumation of nitrogenous waste products in the blood
76
Tubulointerstitial Nephritis (TIN)
decreased renal function due to glomerular damage and swollen interstitial space
77
Why shouldnt Metformin be given once diabetic nephropathy has developed?
risk of lactic acidosis
78
Hepatorenal Syndrome (HRS)
declining renal function related to liver failure, but with normal renal histology * renal vasoconstriction * decreased GFR * prerenal azotemia
79
uremia
nitrogenous waste products in the blood
80
GFR less than _____ will require dialysis
15
81
normal GFR
90 - 120 mL/min/1.73m2
82
Pylonephritis
pus and inflammation of the kidneys * likely to cause sepsis in older patients
83
definition of morbidly obese
greater than 40 BMI
84
elective surgery should wait ____ weeks after resolution of a cold
2 - 4
85
aortic valve stenosis less than ____ is considered severe
1 cm2
86
each hospital should carry ____ bottles of Dantrolene if they have Sux or agents
32
87
SAMBA [abbreviation]
Society for AMBulatory Anesthesia
88
STOP BANG
* snore * tired * observed apnea * pressure * BMI \> 35 * age \> 50 * neck circumference \> 17in * gender: male
89
Aldrete Score
scoring system to move patients from phase I recovery to phase II * respiration * oxygenation * consciousness * circulation * activity
90
PADS score
modification of Aldrete score with inclusion of pain and PONV
91
Anti-prostaglandin used for PONV
Dexamethasone
92
Anti-dopaminergic used for PONV
Droperidol
93
NK-1 Antagonist used for PONV
aprepitant
94
Pf ratio in Acute Lung Injury
200-300
95
Pf ratio in ARDS
less than 200
96
lab study for Pancreatitis
Amylase
97
indirect marker of tissue perfusion
lactic acid
98
most common sources of sepsis
lung and kidneys
99
Why is vasopressin valuable as a vasoactive drug?
can be used in acidotic patients
100
Milrinone
phosphodiesterase inhibitor vasodilates and increases inotropy (ino-dilator)
101
Two types of Trauma
blunt and penetrating
102
How much blood loss can an adult sustain before developing signs of hypovolemic shock?
20% | (about a liter)
103
common steroid dose in adrenal insufficiency patients
hydrocortisone 100 - 200 mg
104
Vitamin K dependent factors
2, 7, 9, and 10
105
Contraindications for TEE
esophageal pathologies | (TE fistula, esophageal varices)
106
Indications for Pulmonary Artery Catheter
* determining cause of shock * pulmonary hypertension * pericardial tamponade * fluid management * burns, sepsis, renal failure, heart failure, or decompensated cirrhosis
107
pulmonary embolism is a type of _____ shock
obstructive
108
Anaphylaxis
IgE antibody-mediated reaction
109
Clinical symptoms of Anaphylaxis
* urticaria * nausea * abdominal pain * laryngeal edema * bronchospasm * cardioavascular collapse
110
most common cause of anaphylactic reactions outside of the OR
Penicillin
111
Red Man Syndrome
caused by histamine release due to bolus of **Vancomycin** * must be given over 1 hour
112
Multiple Antibiotic Allergy Syndrome risk factors
female, history of reactions, and NSAIDS
113
most contrast allergies are related to \_\_\_\_\_
iodine
114
drug for normothermic shivering
12.5 mg of Demerol
115
Benefits of Infusions over bolusing
* improved cardiopulmonary stability * predictable plasma drug concentration * reduced need for supplemental anesthetics * faster recovery
116
Succinylcholine dose for Laryngospasm
0.1 mg/kg or 20 mg
117
Aspiration Pneumonitis | (Mendelson's Syndrome)
chemical injury to the lungs caused by inhalation of gastric contents * signs will appear in 2 hours * treat with suction and bronchodilators
118
Aspiration Pneumonia
inhalation of particulates that become colonized by bacteria
119
Pre-renal AKI
decrease renal perfusion due to decreased blood volume or impaired renal hemodynamics
120
Post-renal AKI
obstructino of urinary flow
121
amoung of glucose in 1 amp
25 grams
122
Causes of hypovolemia in PACU
inadequate fluid repalcement ongoing hemorrhage fluid sequestration (3rd spacing)
123
Blood component Therapy
process of transfusing only the portion of blood needed by the patient
124
Plasma makes up ____ of total blood volume
55%
125
shelf-life of PRBC
42 days
126
1 Unit of platelets will increase platelet count by \_\_\_\_\_
10,000 per mm3
127
1 unit of FFP increases coagulation factors by \_\_\_\_\_
7-8%
128
1 unit of cryoprecipitate will increase fibrinogen by \_\_\_\_\_
20-30 mg per 100 mL
129
indications for Cryoprecipitate
fibrinolysis or acute DIC
130
frozen expiration date for Cryoprecipitate
1 year * thawed cryo will expire in 4 hours
131
AHTR
Acute Hemolytic Transfusion Reaction
132
Acute Hemolytic Transfusion Reaction
occurs when ABO incompatible blood is tranfsued
133
Delayed hemolytic transfusion reaction
occurs with incompatibility of minor antigens * presents 2 days to months after exposure * signs: anemia and jaundice
134
most common transfusion reaction
febrile non-hemolytic transfusion reaction
135
febrile non-hemolytic transfusion reaction is most common with \_\_\_\_\_
platelets
136
cause of febrile non-transfusion reaction
anti-leukocyte antibodies reacting with white blood cells in transfused blood product * most commonly found with FFP
137
allergic transfusion reaction
caused by recipient antibody response to donor plasma proteins
138
Transfusion Related Acute Lung Injury
severe pulmonary insufficiency following blood transfusion * caused by recipient WBC and donor leukocyte antibodies
139
Creutzfeldt–Jakob disease
degenerative neurological disease caused by prions * possibly infection in blood transfusion
140
filter for PRBC
at least 150 microns
141
A "superpack" of platelets will raise the patient's platelet count by \_\_\_\_\_\_
25,000 cells per mm3
142
Transfusing Platelets
3 mL/kg/hr * do not transfuse after PRBC * use a 170-260 micron filter
143
FFP should be given if PT and/or PTT are ____ above normal
1.5x
144
1 FFP should be given for every ____ units of PRBC
2 prevents dilutional coagulopathies
145
Cryoprecipitate
contains fibrinogen and Factor VIII * indicated for Hemophilia A and hypofibrinogenemia
146
Indications for blood transfusion
* VO2 \< 100 mL/min/m2 * O2ER \> 0.5 * correction of Hb \< 7.0
147
#1 cause of transfusion related death in the US
TRALI
148
Delayed non-immune responses to transfusion
* infection * hep B \> hep C \> HIV * iron overload
149
Calcium Chelation has the same signs and symptoms as \_\_\_\_\_
hypocalcemia
150
Citrate is metabolized by the \_\_\_\_\_
liver
151
Which is the best method of induction for a patient with epiglottitis?
inhalational induction with sevo
152
What is NOT an indicator of epiglottitis?
barking cough
153
What is the treatment for severe hypermagnesemia?
hemodialysis
154
What two electrolyte abnormalities can be treated with magnesium?
hypomagnesemia and hypokalemia
155
Dose of methylene blue to treat methemoglobinemia
1 mg/kg over 5-30 minutes
156
In a patient with methemoglobinemia, what happens to the oxygen-hemoglobin dissociation curve?
shifted to left
157
The presence of carboxyhemoglobin causes a(n) _______ shift in the oxy-Hb dissociation curve
left
158
A patient with carboxyhemoglobin toxicity will have a pulse ox reading that is \_\_\_\_\_.
falsely elevated
159
Autonomic Hyperreflexia occurs in response to a noxious stimulus in patients with chronic spinal cord lesions above what level?
T-7
160
What are the typical signs of Autonomic Hyperreflexia?
bradycardia and hypertension
161
What effect does methadone have on the ECG?
QTc prolongation
162
dose of Methadone is ____ more than morphine
4x
163
Which arrhythmias is commonly found in patients with advanced HOCM?
atrial fibrillation
164
What valve is obstructed in HOCM?
mitral valve
165
What is the most common drug of choice for anesthesia providers?
opioids
166
Desmopressin is useful in patients with what type of von Willebrand’s Disease?
quantitative
167
risk of using desmopressin on a patient with Type IIb von Willebrand’s Disease
thrombocytopenia
168
During a case the patient’s ECG shows Torsades de pointes, what is your initial treatment?
1 - 2 g magnesium
169
prolonged QTc range
460-480 ms
170
What nerve is mainly responsible for motor innervation of most of the pharynx and larynx, including the muscles responsible for laryngospasm?
CN XI | (accessory)
171
what local anesthetic causes methemoglobinemia?
prilocaine
172
Which is not a risk factor for hypotension during neuraxial anesthesia?
younger than 50
173
Bradycardia associated with neuraxial anesthesia is mediated by \_\_\_\_\_
sympathetic blockade at T1-T4
174
criteria for diagnosis of brain death
* loss of cerebral function * loss of brainstem function * supporting documentation
175
order of organ procurement
heart \> lungs \> liver \> pancreas \> intestine \> kidney
176
how much Heparin is given during organ procurement?
30,000 units | (300 units per kg)
177
when does anesthesia time end in an organ procurement?
aortic cross-clamp
178
if harvesting heart and/or lungs, FiO2 should be kept below \_\_\_\_\_
40%
179
CVP goal during organ procurement
10 -12 cmH2O | (6 - 8 if lungs procured)
180
How should you treat hypertension during organ procurement?
volatile agents or nitrates
181
Allopurinol
used to treat gout or kidney stones and to decrease levels of uric acid * often given during organ procurement * free radical scavenger
182
Systemic effects likely seen in chronic ESRD
* anemia * electrolyte disturbances * fluid imbalances * platelet dysfunction * acid-base irregularities
183
Common electrolyte abnormalities in ESRD
* hypo- * natremia and calcemia * hyper- * kalemia, phosphatemia, magnesemia
184
Should anemic patients with ESRD be transfused before surgery?
no, they have adapted to chronic anemia * obtain Type and Cross instead * right shift of oxyhemoglobin curve
185
best induction drug for ESRD
etomidate * labile BP and unpredictable volume status
186
RSI dose of Roc
1.2 mg/kg
187
which narcotics should not be given in ESRD?
morphine and demerol
188
Fenoldopam
Dopamine-1 agonist * antihypertensive * good for kidneys
189
Why is Ketoralac contraindicated in patients with compromised renal function?
Ketoralac is a COX inhibitor * inhibits prostaglandin synthesis leading to decreased GFR, decreased renal blood flow, and increased renal vascular resistance * may result in hyperkalemia
190
ATN
Acute Tubular Necrosis
191
2 major causes of acute tubular necrosis
ischemia and nephrotoxins
192
most common cause of renal failure in the peri-operative period
acute tubular necrosis (ATN)
193
Pre-renal oliguria
inadequate urinary output usually less than 0.5 ml/kg/hr
194
Acute Kidney Injury (AKI)
abrupt reduction in kidney function * within 48 hours * creatinine 1.5x baseline * 50% reduction in urine output
195
Chronic Kidney Disease (CKD)
decreased GFR that persists for over 3 months
196
generic name for Procaine
Novocain
197
generic name for Bupivacaine
marcaine
198
generic name for mepivacaine
carbocaine
199
generic name for Ropivacaine
naropin
200
generic name for 2-chloroprocaine
nesacaine
201
alveolar oxygen tension
110 mmHg PAO2 = FiO2(PB-PH2O) - (PaCO2/0.8)
202
Alveolar-Arterial Oxygen Gradient
\< 10mmHg if FiO2 = 0.21 \< 60mmHg if FiO2 = 1 A-aO2 = PAO2 - PaO2
203
normal a/A ratio
\> 0.75
204
physiologic dead space equation
VD/VT = (PaCO2 - PECO2) / PaCO2 0.33
205
Arterial Oxygen Content eqation
21 mL O2/100mL CaO2 = (Hb \* 1.36 \* SaO2) + (PaO2 \* 0.0031)
206
Mixed Venous Oxygen Content equation
15 mL O2/ 100mL | (Hb \* 1.36 \* SvO2) + (PvO2 \* 0.0031)
207
normal oxygen consumption
3.5 mL O2/kg/min CO \* (CaO2 - CvO2) \* 10 [about 110 - 140]
208
what type of physiologic disturbance do patients have with mitral stenosis?
decreased ventricular filling and increased pulmonary vascular resistance
209
hemodynamic goals in mitral stenosis
decrease HR and PVR
210
SIRS
Systemic Inflammatory Response Syndrome
211
criteria for SIRS
* fever above 38 oC or lower than 36 * heart rate \> 90 * RR \> 20 or PaCO2 \< 32 mmHg * WBC \> 12,000 or less than 4,000
212
Sepsis
characterized by SIRS with organ dysfunction
213
Septic shock
hypermetabolic state leading to metabolic acidosis and multi-organ dysfunction syndrome
214
common cause of septic shock
gram negative bacteria mainly from GU tract or lungs
215
infusion rate of vasopressin
0.01 - 0.04 units/minute
216
Propofol Infusion Syndrome
greater than 5 mg/kg/hr for over 48 hours
217
What is the incidence of herbal medicine use in the surgical population?
40% mostly women
218
Ephedra
used to boost increase and weight loss * cardiovascular and CNS stimulant * can cause severe hypertension, MI, seizures, or CVA
219
Vitamin E
used as an antioxidant * antagonist of Vitamin K * may decrease clotting and platelet aggregation
220
Fish Oil
used for hyperlipidemia, hypertension, and inflammation * decrease blood viscosity and platelet function
221
Gingko
mental awareness * inhibits platelet aggregation
222
Ginseng
general well-being * hypertension and CNS stimulant * intereferes with platelet aggregation
223
Ginger
anti-nausea and arthritis * decrease platelet function
224
Anaphylactoid reaction
severe non-immune mediate reaction * inflammatory mediators released from mast cells and basophils
225
Most common organ injured in penetrating trauma
liver
226
most common organ injured in blunt trauma
spleen
227
portal triad
portal vein, hepatic artery, and common bile duct
228
What are leukocyte reduced red blood cells used for?
For patients with previous febrile transfusion reactions
229
Which blood component has the greatest risk of transmission of infectious disease?
platelets
230
storage defects that occur in stored blood
* decreased * pH * 2,3 DPG * ATP * glucose * clotting factors V and VIII * increased * potassium * phosphate
231
decreased reticulocyte count
inability of the body to produce RBCs
232
Common causes of prolonged PTT
Hemophilia A and B and von Willebrand's
233
common cause of prolonged PT
vitamin K deficiency
234
common cause of prolonged PT and PTT
heparin and Coumadin
235
Common causes of Thrombocytopenia
H.I.D. * hypersplenism * idiopathic thrombocytopenia purpura * drugs, dilutional, DIC
236
common causes of inhibited platelet function
* aspirin * uremia * von Willebrand's disease
237
If one blood volume has been transfused, about _____ of platelets will be lost
65%
238
Normal PT
12 - 14 sec
239
Normal PTT
25 - 35 sec
240
Normal INR
1 - 1.2
241
Which procoagulant is not synthesized in the liver?
Factor 8 synthesized in the reticuloendothelial system
242
Hemophilia A
factor 8 deficient
243
Hemophilia B
factor 9 deficient treat with recombinant factor 9 or FFP
244
von Willebrand's disease
decreased factor 8 and a protein for platelet function
245
How is vonWillebrand’s disease treated?
Factor 8 concentrate (Humate P) orDDAVP Cryoprecipitate can also be used but is less efficient
246
DDAVP
synthetic analogue of vasopressin temporarily increases factor 8 and vWF complex by increasing their release from endothelial cells
247
HOCM
Hypertrophic Obstructive Cardiomyopathy
248
Hypertrophic Obstructive Cardiomyopathy
severe hypertrophy of the myocardium. * intraventricular septum moves towards the mitral valve during systole causing LV outflow obstruction
249
most common cause of sudden cardiac death in young athletes
Hypertrophic Obstructive Cardiomyopathy
250
Anesthetic goals in the management of a patient with HOCM
* Adequate preload * Maintain afterload * slightly decreased HR * avoid increased contractility and sympathetic stimulation
251
What valvular disorder can result from severe HOCM and systolic anterior motion?
mitral regurgitation
252
When should one treat Hyperkalemia?
over 6 mEq/L
253
What are treatment options for acute Hyperkalemia?
* Calcium * Sodium Bicarbonate * Beta agonists * Low dose epinephrine * Glucose and insulin * Hyperventilation * Dialysis * Lasix
254
autonomic storm
* tachycardia * hypertension * vasoconstriction * elevated catecholamines
255
3 major parameters measured with SSEPs
* Amplitude * Latency * Central conduction time
256
clinically significant changes in the SSEP
Decrease in amplitude by 50% Increase in latency by 10%
257
Hyperbaric Oxygen Therapy
administration of 100% O2 above normal atmospheric pressure – usually at 2-3 atm
258
methemoglobinemia
Fe in Hgb becomes oxidized and thus has less affinity for oxygen binding
259
classic X-ray finding in epiglottitis
"thumb pring sign"
260
How long before a neuraxial block should a patient discontinue NSAID's
3 days
261
How long before a neuraxial block should a patient discontinue Coumadin
5 days
262
How long before a neuraxial block should a patient discontinue ASA or plavix?
7 days
263
What risk factors place a patient at higher risk of hypotension after a spinal block?
* obesity * over 40 y.o. * hypovolemia * medications like ACE inhibitors and ARBs
264
location of cardioaccelerator fibers
T1 - T4
265
CRPS
Complex Regional Pain Syndrome
266
When performing a Stellate ganglion block, one seeks to inject the local anesthetic at “Chassaignac’s Tubercle”. What are the landmarks used to find this tubercle?
6th cervical vertebrae, lateral to the cricoid, and medial to the carotid artery
267
Horner's Syndrome
miosis, ptosis, and anhydrosis * often occurs with stellate ganglion block
268
how will Furosemide affect NDMB?
prolong effects furosemide decreases release of ACh
269
Magnesium will enhance the efficacy of both nondepolarizing and depolarizing NMBD’s. What is the mechanism?
blocks the prejunctional Calcium channels which decreases the release of Ach * Potentiation of Sux most likely due to effect of Mg on pseudocholinesterase
270
Which of the volatile agents is best at enhancing the efficacy of Nondepolarizing NMBD’s?
Desflurane \> Sevoflurane\> Isoflurane\> Halothane \>N2O
271
What is the treatment of hypermagnesemia?
* Lasix * Calcium Gluconate 1 gm * Hemodialysis * Volume expansion
272
What are the signs and symptoms of Autonomic Hyperreflexia?
* Hypertension * Dysrthythmias * Bradycardia * Mydriasis * Flushing above the SCI level * Nasal Congestion * Headache
273
normal cardiac index
2.8 - 4.2 L/min/m2
274
normal stroke volume
60 - 90 mL/beat
275
normal stroke index
40 - 60 mL/beat/m2
276
systemic vascular resistance
900 - 1400 dynes*sec/cm (MAP - CVP)/CO \* 80
277
normal systemic vascular resistance index
1900 - 2400 dynes*sec/cm5
278
Pulmonary Vascular Resistance
100 - 250 dynes*sec/cm5 (PAP - PCWP)/CO \* 80
279
normal Pulmonary Vascular Resistance Index
45 - 225 dynes*sec/cm5
280
Cerebral blood flow determinants
281
normal cerebral perfusion pressure
50 - 150 mmHg
282
normal cerebral blood flow
50 mL/100g
283
normal cerebral metabolic rate
3.0 - 3.8 mL/100g
284
cerebral blood flow increases _____ for every 1 mmHg increase in PaCO2
1 mL/100g/min
285
in cerebral autoregulation, below 50mmHg, vessels are maximally dialted and pressure ______ flow
dependent
286
chronic hypertension shifts the cerebral autoregulation curve to the \_\_\_\_\_
right
287
volatile agents effect on CMRO2
decrease results in uncoupling of CBF and CMRO2
288
N2O and cerebral blood flow
less effect and does not interfere with autoregulation * Tension Pneumocephalus possible if nitrous oxide used after dural closure
289
normal intracranial pressure
5 - 15 mmHg
290
Intracranial Elastance Curve
intracranial pressure vs volume * patient can no longer compensate increase in intracranial volume past point 2-3
291
(3) measurements of ICP
subdural bolt ventriculostomy lumbar subarachnoid catheter
292
most common infratentorial tumor in adults
acoustic neuroma
293
"Triple H" Therapyfor Cerebral Aneurysm
hypervolemia, hypertension, and hemodilution
294
Hunt-Hess Grading System
classifies subarachnoid hemorrhages * 1 - Asymptomati * 5 - deep coma
295
Spetzler Martin Grading
classifies Arteriovenous Malformations
296
Parkinson's Disease
degeneration of substantia niagra of the basal ganglia that decreases dopamine production
297
ketamine's effect on neuroanesthesia
increases CBF and CMRO2
298
Propofol's effect on neuroanesthesia
decreases CBF and CMRO2
299
volatile agent's effect on neuroanesthesia
increases CBF, but decreases CMRO2
300
VP shunt
ventriculoperitoneal shunt * treatment for hydrocephalus
301
gold standard for neurologic assessment during a carotid endarterectomy
monitoring while awake
302
acute MI vs recent
acute - 7 day or less recent - 7 days to 1 month
303
osmolarity of normal saline
308
304
osmolarity of lactated ringer
273
305
osmolarity of dextrose 5%
252
306
normal serum osmolarity
275- 295
307
components in normal saline
sodium and chloride
308
components in lactated ringer
sodium, chloride, potassium, calcium, and lactate
309
components in dextrose 5%
50 g/L glucose
310
JCAHO
Joint Commission on the Accreditation of Healthcare Organizations
311
OSHA
Occupational Safety and Health Administration
312
HIPAA
Health Insurance Portability and Accountability
313
How to determine if a baby is dehydrated
sunken fontanelles
314
normal platelet count
150k - 400k
315
normal glucose level
70 - 110 mg/dL
316
Metoclopromide [contraindications]
Parkinson's, Alzheimer's, and bowel resection
317
Most common nerve injury from positioning
ulnar | (Peroneal if in lithotomy)
318
Where does the spinal cord end?
L1 - L2 | (L3 in children)
319
TURP
Trans-Uretheral Resection of the Prostate
320
(5) Causes of Hyperthermia
* thrombophlebitis * urinary tract infection * atelectasis or aspiration * wound infection * wonder drugs (cocaine, amphetamines)
321
Shivering increases oxygen consumption by \_\_\_\_\_%
400-500%
322
**Droperidol** [dose]
0.02 - 0.03 mg/kg
323
Ondansetron [mechanism of action]
5-HT3 antagonist
324
**Metoclopromide** [dose]
10 mg
325
Reasons that patient can't awaken [SOAP]
* Stroke * overdose * acidosis/alkalosis * paralysis
326
most common reason of inadequate reversal of non-depolarizer
hypothermia
327
Hypotension Diagnosis [TED FARIOS]
* Temperature * embolus * drugs * fluid deficiency * anesthesia too deep * rhythm problem * inotropy problem * oxygen deficiency * surgical compression
328
spinal [layers of advancement]
* skin * sub-q * supraspinous ligament * interspinous ligament * ligamentum flavum * epidural space * dura/arachnoid
329
normal BUN
10 - 20 mg/dL
330
surgical procedure to correct a hernia
herniorraphy
331
TURBT
Trans-Urethral Resection of Bladder Tumor
332
relocation of balls
orchiopexy
333
Diabetic Ketoacidosis
accumulation of ketone acids due to lack of insulin * Type I diabetes
334
ALS
Amyotropic Lateral Sclerosis
335
Amyotropic Lateral Sclerosis
aka Lou Gehrig's disease * progressive loss of motor function * asymmetric weakness of limbs * avoid succinylcholine * increased sensitivity to NDMR
336
Multiple Sclerosis
demyelinating process of brain and spinal cord
337
Guillian-Barre Syndrome
polyneuropathy of motor, sensory, and autonomic nerves * ascending muscle weakness * (ground to brain) * avoid succinylcholine * hypersensitive to NDMR
338
Myasthenia Gravis
auto-immune disease of neuromuscular junction * descending * symptoms improve with rest
339
Eaton-Lambert Syndrome
autoimmune disorder of neuromuscular junction associated with carcinomas * Myasthenic syndrome * muscle weakness not improved with anti-cholinesterases
340
Fat Embolus [(5) diagnosis]
* tachycardia * hyperthermia * urinary fat globules * decreased platelets * DIC
341
Tourniquet [pressure]
100 mmHg above systolic for lower extremities 50 mmHg above for upper extremities
342
surgical removal of the thymus
Thymectomy
343
ERCP
Endoscopic Retrograde Cholangio-Pancreatography
344
repair of an abnormal opening in the diaphragm allowing abdominal organs to migrate into chest wall
Diaphragmatic Hernia Repair
345
Thyroid Storm [management]
* propylthiuracil * hydrocortisone * digoxin * propanolol * acetaminophen * Na Iodide * IV fluids * cooling blankets
346
What hormone does the adrenal cortex produce?
mineralcorticoids (aldosterone) corticosteroids glucocorticoids (cortisol) androgens
347
posterior pituitary [hormone secretion]
vasopressin and oxytocin
348
SIADH
Syndrome of Inappropriate Anti-Diuretic Hormone
349
Mediastinoscopy [monitors]
pulse ox or arterial line on right hand to detect compression of innominate artery
350
Triple H Therapy for Cerebral Vasospasm
hypervolemia, hypertension, and hemodilution
351

Comprehensive Exam (6 decks)

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