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Comprehensive Exam > Anesthesia Sciences > Flashcards

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
Q

benzodiazepine reversal

A

flumazenil 0.2 mg

(repeat every minute up to 1mg)

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26
Q

Scopolomine reversal

A

Physostigmine 1 mg

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27
Q

Immediate actions of Airway Fire

A

stop all gas flow

  • re-establish ventilation
  • reintubate

Surgeon will remove ETT and pour saline into airway

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28
Q

equation for estimated blood loss

A

EBV x (HCTstart - HCTmeasured) / HCTstart

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29
Q

differential diagnosis for Hypotension

A
  • hemorrhage
  • anesthetic overdose
  • auto-PEEP
  • anaphylaxis
  • MI
  • pneumoperitoneum
  • IVC compression
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30
Q

Pneumoperitoneum

A

gas in the peritoneal cavity

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31
Q

4 factors in determining hypotension

A

decreased preload

low SVR

decreased contractility

low HR

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32
Q

Signs of Local Anesthetic Toxicity

A
  • tinnitus or metallic taste
  • altered mental status
  • seizures
  • hypotension
  • bradycardia
  • ventricular arrhythmias
  • cardiovascular collapse
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33
Q

Treatment for Local Anesthetic Toxicity

A

1.5 mL/kg bolus of 20% intralipid

then

0.25 mL/kg/min infusion

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34
Q

what should you avoid in local anesthetic toxicity?

A

vasopressin, CCB, BB, and local anesthetics

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35
Q

early signs of Malignant Hyperthermia

A
  • increased EtCO2
  • tachycardia
  • tachypnea
  • mixed acidosis (ABG)
  • masseter spasm
  • sudden cardiac arrest due to hyperkalemia
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36
Q

later signs of malignant hyperthermia

A
  • hyperthermia
  • muscle ridigity
  • myoglobinuria
  • arrhythmias
  • cardiac arrest
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37
Q

differential diagnosis of Malignant Hyperthermia

A
  • light anesthesia
  • hypoventilation
  • insufflation of CO2
  • hypoxemia
  • thyroid storm
  • pheochromocytoma
  • neuroleptic malignant syndrome (NMS)
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38
Q

dose of Dantrolene

A

2.5 mg/kg

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39
Q

what else should be given with dantrolene in MH?

A

sodium bicarb 1-2 mEq/kg

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40
Q

MHAUS

A

Malignant Hyperthermia Association of the US

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41
Q

Signs of Pneumothorax

A
  • increased peak inspiratory pressures
  • tachycardia
  • hypotension
  • hypoxemia
  • decreased breath sounds
  • hyperresonance to chest percussion
  • tracheal deviation
  • increased JVD/CVP
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42
Q

treatment for Pneumothorax

A

14 or 16 gauge needle in mid-clavicular line 2nd intercostal space

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43
Q

color of 14 Gauge catheter

A

orange

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44
Q

color of 16 Gauge catheter

A

Grey

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45
Q

color of 18 Gauge catheter

A

Green

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46
Q

color of 20 Gauge catheter

A

pink

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47
Q

color of 22 Gauge catheter

A

blue

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48
Q

color of 24 Gauge catheter

A

yellow

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49
Q

Signs of Total Spinal Anesthesia

A
  • unexpected rapid rise in senosry block
  • numbess in upper extremities
  • dyspnea
  • bradycardia
  • hypotension
  • loss of consciousness
  • apnea
  • cardiac arrest
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50
Q

Signs of a Hemolytic Transfusion Reaction

A
  • tachycardia
  • tachypnea
  • hypotension
  • DIC
  • dark urine
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51
Q

Signs of Venous Air Embolus

A
  • air on TEE or change in doppler tone
  • decrease
    • ETCO2
    • BP
    • SPO2
  • rise in CVP
  • respiratory distress or cough
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52
Q

Treatment for Air Embolus

A
  • 100% O2
  • flood surgical field
  • surgical site below heart
  • aspirate air from central line
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53
Q

Patients with chronic liver dysfunction and cirrhosis have a ______ circulation with ______ PVR and ____ cardiac index

A

hyperdynamic circulation

low peripheral vascular resistance

increased cardiac index

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54
Q

most common indication for liver transplantation

A

chronic hepatocellular disease

due to alcohol and/or hepatitis (mostly C)

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55
Q

Preanhepatic phase of liver transplantation

A

complete hepatectomy

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56
Q

Anhepatic phase of liver transplant

A

vascular anastomoses between the donor liver and recipient’s vessels

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57
Q

neohepatic phase of liver transplant

A

hepatic artery and biliary anastomoses are constructed

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58
Q

(2) common techniques for liver transplantation

A

en-block and piggyback

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59
Q

(2) patient classifications for liver disease

A

Child-Pugh Classification

and

Model for End-Stage Liver Disease (MELD)

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60
Q

Model for End-Stage Liver Disease

A

measures creatinine, bilirubin, INR

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61
Q

Hematologic co-morbidities in Liver Disease

A
  • anemia
  • thrombocytopenia
  • prolonged PT and PTT
  • decreased plasma fibrinogen
  • DIC
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62
Q

potential post-operative complications of liver transplant

A
  • massive transfusion related
  • anastomotic leaks
  • central pontine myelinolysis
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63
Q

Most common cause of death in transplant recipients

A

infection

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64
Q

major indications of kidney transplant

A
  • diabetes
  • hypertension induced nephropathy
  • glomerulonephritis
  • polycystic kidney disease
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65
Q

CVP during kidney transplant

A

10 - 15 mmHg

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66
Q

50% of post kidney transplant deaths are _____

A

cardiac related

detection of coronary artery disease in patients prior to transplantation is vital

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67
Q

goal systolic blood pressure during renal transplant

A

130-140 mmHg

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68
Q

UNOS

A

United Network for Organ Sharing

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69
Q

wood units

A

measures pulmonary vascular resistance

  • must have less than 6 wood units for cardiac transplant
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70
Q

What should be given prior to unclamping and reperfusion of new heart?

A

corticosteroids

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71
Q

target heart rate after bypass

A

90 - 110 bpm

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72
Q

TIPS

A

Transjugular Intrahepatic Portosystemic Shunt

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73
Q

Prerenal Azotemia

A

normal physiological response to decreased renal perfusion that leads to a reduction in GFR

  • accounts for 70% of hospital-aquired ARF
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74
Q

Nephritic vs Nephrotric

A

Nephritic: inadequate glomerular filtration

Nephrotic: excessive filtration

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75
Q

Azotemia

A

acculumation of nitrogenous waste products in the blood

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76
Q

Tubulointerstitial Nephritis (TIN)

A

decreased renal function due to glomerular damage and swollen interstitial space

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77
Q

Why shouldnt Metformin be given once diabetic nephropathy has developed?

A

risk of lactic acidosis

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78
Q

Hepatorenal Syndrome (HRS)

A

declining renal function related to liver failure, but with normal renal histology

  • renal vasoconstriction
  • decreased GFR
  • prerenal azotemia
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79
Q

uremia

A

nitrogenous waste products in the blood

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80
Q

GFR less than _____ will require dialysis

A

15

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81
Q

normal GFR

A

90 - 120 mL/min/1.73m2

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82
Q

Pylonephritis

A

pus and inflammation of the kidneys

  • likely to cause sepsis in older patients
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83
Q

definition of morbidly obese

A

greater than 40 BMI

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84
Q

elective surgery should wait ____ weeks after resolution of a cold

A

2 - 4

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85
Q

aortic valve stenosis less than ____ is considered severe

A

1 cm2

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86
Q

each hospital should carry ____ bottles of Dantrolene if they have Sux or agents

A

32

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87
Q

SAMBA

[abbreviation]

A

Society for AMBulatory Anesthesia

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88
Q

STOP BANG

A
  • snore
  • tired
  • observed apnea
  • pressure
  • BMI > 35
  • age > 50
  • neck circumference > 17in
  • gender: male
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89
Q

Aldrete Score

A

scoring system to move patients from phase I recovery to phase II

  • respiration
  • oxygenation
  • consciousness
  • circulation
  • activity
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90
Q

PADS score

A

modification of Aldrete score with inclusion of pain and PONV

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91
Q

Anti-prostaglandin used for PONV

A

Dexamethasone

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92
Q

Anti-dopaminergic used for PONV

A

Droperidol

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93
Q

NK-1 Antagonist used for PONV

A

aprepitant

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94
Q

Pf ratio in Acute Lung Injury

A

200-300

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95
Q

Pf ratio in ARDS

A

less than 200

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96
Q

lab study for Pancreatitis

A

Amylase

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97
Q

indirect marker of tissue perfusion

A

lactic acid

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98
Q

most common sources of sepsis

A

lung and kidneys

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99
Q

Why is vasopressin valuable as a vasoactive drug?

A

can be used in acidotic patients

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100
Q

Milrinone

A

phosphodiesterase inhibitor

vasodilates and increases inotropy (ino-dilator)

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101
Q

Two types of Trauma

A

blunt and penetrating

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102
Q

How much blood loss can an adult sustain before developing signs of hypovolemic shock?

A

20%

(about a liter)

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103
Q

common steroid dose in adrenal insufficiency patients

A

hydrocortisone 100 - 200 mg

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104
Q

Vitamin K dependent factors

A

2, 7, 9, and 10

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105
Q

Contraindications for TEE

A

esophageal pathologies

(TE fistula, esophageal varices)

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106
Q

Indications for Pulmonary Artery Catheter

A
  • determining cause of shock
  • pulmonary hypertension
  • pericardial tamponade
  • fluid management
    • burns, sepsis, renal failure, heart failure, or decompensated cirrhosis
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107
Q

pulmonary embolism is a type of _____ shock

A

obstructive

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108
Q

Anaphylaxis

A

IgE antibody-mediated reaction

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109
Q

Clinical symptoms of Anaphylaxis

A
  • urticaria
  • nausea
  • abdominal pain
  • laryngeal edema
  • bronchospasm
  • cardioavascular collapse
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110
Q

most common cause of anaphylactic reactions outside of the OR

A

Penicillin

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111
Q

Red Man Syndrome

A

caused by histamine release due to bolus of Vancomycin

  • must be given over 1 hour
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112
Q

Multiple Antibiotic Allergy Syndrome risk factors

A

female, history of reactions, and NSAIDS

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113
Q

most contrast allergies are related to _____

A

iodine

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114
Q

drug for normothermic shivering

A

12.5 mg of Demerol

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115
Q

Benefits of Infusions over bolusing

A
  • improved cardiopulmonary stability
  • predictable plasma drug concentration
  • reduced need for supplemental anesthetics
  • faster recovery
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116
Q

Succinylcholine dose for Laryngospasm

A

0.1 mg/kg

or

20 mg

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117
Q

Aspiration Pneumonitis

(Mendelson’s Syndrome)

A

chemical injury to the lungs caused by inhalation of gastric contents

  • signs will appear in 2 hours
  • treat with suction and bronchodilators
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118
Q

Aspiration Pneumonia

A

inhalation of particulates that become colonized by bacteria

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119
Q

Pre-renal AKI

A

decrease renal perfusion due to decreased blood volume or impaired renal hemodynamics

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120
Q

Post-renal AKI

A

obstructino of urinary flow

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121
Q

amoung of glucose in 1 amp

A

25 grams

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122
Q

Causes of hypovolemia in PACU

A

inadequate fluid repalcement

ongoing hemorrhage

fluid sequestration (3rd spacing)

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123
Q

Blood component Therapy

A

process of transfusing only the portion of blood needed by the patient

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124
Q

Plasma makes up ____ of total blood volume

A

55%

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125
Q

shelf-life of PRBC

A

42 days

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126
Q

1 Unit of platelets will increase platelet count by _____

A

10,000 per mm3

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127
Q

1 unit of FFP increases coagulation factors by _____

A

7-8%

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128
Q

1 unit of cryoprecipitate will increase fibrinogen by _____

A

20-30 mg per 100 mL

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129
Q

indications for Cryoprecipitate

A

fibrinolysis or acute DIC

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130
Q

frozen expiration date for Cryoprecipitate

A

1 year

  • thawed cryo will expire in 4 hours
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131
Q

AHTR

A

Acute Hemolytic Transfusion Reaction

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132
Q

Acute Hemolytic Transfusion Reaction

A

occurs when ABO incompatible blood is tranfsued

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133
Q

Delayed hemolytic transfusion reaction

A

occurs with incompatibility of minor antigens

  • presents 2 days to months after exposure
  • signs: anemia and jaundice
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134
Q

most common transfusion reaction

A

febrile non-hemolytic transfusion reaction

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135
Q

febrile non-hemolytic transfusion reaction is most common with _____

A

platelets

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136
Q

cause of febrile non-transfusion reaction

A

anti-leukocyte antibodies reacting with white blood cells in transfused blood product

  • most commonly found with FFP
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137
Q

allergic transfusion reaction

A

caused by recipient antibody response to donor plasma proteins

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138
Q

Transfusion Related Acute Lung Injury

A

severe pulmonary insufficiency following blood transfusion

  • caused by recipient WBC and donor leukocyte antibodies
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139
Q

Creutzfeldt–Jakob disease

A

degenerative neurological disease caused by prions

  • possibly infection in blood transfusion
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140
Q

filter for PRBC

A

at least 150 microns

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141
Q

A “superpack” of platelets will raise the patient’s platelet count by ______

A

25,000 cells per mm3

142
Q

Transfusing Platelets

A

3 mL/kg/hr

  • do not transfuse after PRBC
  • use a 170-260 micron filter
143
Q

FFP should be given if PT and/or PTT are ____ above normal

A

1.5x

144
Q

1 FFP should be given for every ____ units of PRBC

A

2

prevents dilutional coagulopathies

145
Q

Cryoprecipitate

A

contains fibrinogen and Factor VIII

  • indicated for Hemophilia A and hypofibrinogenemia
146
Q

Indications for blood transfusion

A
  • VO2 < 100 mL/min/m2
  • O2ER > 0.5
  • correction of Hb < 7.0
147
Q

1 cause of transfusion related death in the US

A

TRALI

148
Q

Delayed non-immune responses to transfusion

A
  • infection
    • hep B > hep C > HIV
  • iron overload
149
Q

Calcium Chelation has the same signs and symptoms as _____

A

hypocalcemia

150
Q

Citrate is metabolized by the _____

A

liver

151
Q

Which is the best method of induction for a patient with epiglottitis?

A

inhalational induction with sevo

152
Q

What is NOT an indicator of epiglottitis?

A

barking cough

153
Q

What is the treatment for severe hypermagnesemia?

A

hemodialysis

154
Q

What two electrolyte abnormalities can be treated with magnesium?

A

hypomagnesemia and hypokalemia

155
Q

Dose of methylene blue to treat methemoglobinemia

A

1 mg/kg over 5-30 minutes

156
Q

In a patient with methemoglobinemia, what happens to the oxygen-hemoglobin dissociation curve?

A

shifted to left

157
Q

The presence of carboxyhemoglobin causes a(n) _______ shift in the oxy-Hb dissociation curve

A

left

158
Q

A patient with carboxyhemoglobin toxicity will have a pulse ox reading that is _____.

A

falsely elevated

159
Q

Autonomic Hyperreflexia occurs in response to a noxious stimulus in patients with chronic spinal cord lesions above what level?

A

T-7

160
Q

What are the typical signs of Autonomic Hyperreflexia?

A

bradycardia and hypertension

161
Q

What effect does methadone have on the ECG?

A

QTc prolongation

162
Q

dose of Methadone is ____ more than morphine

A

4x

163
Q

Which arrhythmias is commonly found in patients with advanced HOCM?

A

atrial fibrillation

164
Q

What valve is obstructed in HOCM?

A

mitral valve

165
Q

What is the most common drug of choice for anesthesia providers?

A

opioids

166
Q

Desmopressin is useful in patients with what type of von Willebrand’s Disease?

A

quantitative

167
Q

risk of using desmopressin on a patient with Type IIb von Willebrand’s Disease

A

thrombocytopenia

168
Q

During a case the patient’s ECG shows Torsades de pointes, what is your initial treatment?

A

1 - 2 g magnesium

169
Q

prolonged QTc range

A

460-480 ms

170
Q

What nerve is mainly responsible for motor innervation of most of the pharynx and larynx, including the muscles responsible for laryngospasm?

A

CN XI

(accessory)

171
Q

what local anesthetic causes methemoglobinemia?

A

prilocaine

172
Q

Which is not a risk factor for hypotension during neuraxial anesthesia?

A

younger than 50

173
Q

Bradycardia associated with neuraxial anesthesia is mediated by _____

A

sympathetic blockade at T1-T4

174
Q

criteria for diagnosis of brain death

A
  • loss of cerebral function
  • loss of brainstem function
  • supporting documentation
175
Q

order of organ procurement

A

heart > lungs > liver > pancreas > intestine > kidney

176
Q

how much Heparin is given during organ procurement?

A

30,000 units

(300 units per kg)

177
Q

when does anesthesia time end in an organ procurement?

A

aortic cross-clamp

178
Q

if harvesting heart and/or lungs, FiO2 should be kept below _____

A

40%

179
Q

CVP goal during organ procurement

A

10 -12 cmH2O

(6 - 8 if lungs procured)

180
Q

How should you treat hypertension during organ procurement?

A

volatile agents or nitrates

181
Q

Allopurinol

A

used to treat gout or kidney stones and to decrease levels of uric acid

  • often given during organ procurement
  • free radical scavenger
182
Q

Systemic effects likely seen in chronic ESRD

A
  • anemia
  • electrolyte disturbances
  • fluid imbalances
  • platelet dysfunction
  • acid-base irregularities
183
Q

Common electrolyte abnormalities in ESRD

A
  • hypo-
    • natremia and calcemia
  • hyper-
    • kalemia, phosphatemia, magnesemia
184
Q

Should anemic patients with ESRD be transfused before surgery?

A

no, they have adapted to chronic anemia

  • obtain Type and Cross instead
  • right shift of oxyhemoglobin curve
185
Q

best induction drug for ESRD

A

etomidate

  • labile BP and unpredictable volume status
186
Q

RSI dose of Roc

A

1.2 mg/kg

187
Q

which narcotics should not be given in ESRD?

A

morphine and demerol

188
Q

Fenoldopam

A

Dopamine-1 agonist

  • antihypertensive
  • good for kidneys
189
Q

Why is Ketoralac contraindicated in patients with compromised renal function?

A

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
Q

ATN

A

Acute Tubular Necrosis

191
Q

2 major causes of acute tubular necrosis

A

ischemia and nephrotoxins

192
Q

most common cause of renal failure in the peri-operative period

A

acute tubular necrosis (ATN)

193
Q

Pre-renal oliguria

A

inadequate urinary output

usually less than 0.5 ml/kg/hr

194
Q

Acute Kidney Injury (AKI)

A

abrupt reduction in kidney function

  • within 48 hours
  • creatinine 1.5x baseline
  • 50% reduction in urine output
195
Q

Chronic Kidney Disease (CKD)

A

decreased GFR that persists for over 3 months

196
Q

generic name for Procaine

A

Novocain

197
Q

generic name for Bupivacaine

A

marcaine

198
Q

generic name for mepivacaine

A

carbocaine

199
Q

generic name for Ropivacaine

A

naropin

200
Q

generic name for 2-chloroprocaine

A

nesacaine

201
Q

alveolar oxygen tension

A

110 mmHg

PAO2 = FiO2(PB-PH<span>2</span>O) - (PaCO2/0.8)

202
Q

Alveolar-Arterial Oxygen Gradient

A

< 10mmHg if FiO2 = 0.21 < 60mmHg if FiO2 = 1

A-aO2 = PAO2 - PaO2

203
Q

normal a/A ratio

A

> 0.75

204
Q

physiologic dead space equation

A

VD/VT = (PaCO2 - PECO2) / PaCO2

0.33

205
Q

Arterial Oxygen Content eqation

A

21 mL O2/100mL

CaO2 = (Hb * 1.36 * SaO2) + (PaO2 * 0.0031)

206
Q

Mixed Venous Oxygen Content equation

A

15 mL O2/ 100mL

(Hb * 1.36 * SvO2) + (PvO2 * 0.0031)

207
Q

normal oxygen consumption

A

3.5 mL O2/kg/min

CO * (CaO2 - CvO2) * 10

[about 110 - 140]

208
Q

what type of physiologic disturbance do patients have with mitral stenosis?

A

decreased ventricular filling and increased pulmonary vascular resistance

209
Q

hemodynamic goals in mitral stenosis

A

decrease HR and PVR

210
Q

SIRS

A

Systemic Inflammatory Response Syndrome

211
Q

criteria for SIRS

A
  • 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
Q

Sepsis

A

characterized by SIRS with organ dysfunction

213
Q

Septic shock

A

hypermetabolic state leading to metabolic acidosis and multi-organ dysfunction syndrome

214
Q

common cause of septic shock

A

gram negative bacteria

mainly from GU tract or lungs

215
Q

infusion rate of vasopressin

A

0.01 - 0.04 units/minute

216
Q

Propofol Infusion Syndrome

A

greater than 5 mg/kg/hr for over 48 hours

217
Q

What is the incidence of herbal medicine use in the surgical population?

A

40%

mostly women

218
Q

Ephedra

A

used to boost increase and weight loss

  • cardiovascular and CNS stimulant
  • can cause severe hypertension, MI, seizures, or CVA
219
Q

Vitamin E

A

used as an antioxidant

  • antagonist of Vitamin K
  • may decrease clotting and platelet aggregation
220
Q

Fish Oil

A

used for hyperlipidemia, hypertension, and inflammation

  • decrease blood viscosity and platelet function
221
Q

Gingko

A

mental awareness

  • inhibits platelet aggregation
222
Q

Ginseng

A

general well-being

  • hypertension and CNS stimulant
  • intereferes with platelet aggregation
223
Q

Ginger

A

anti-nausea and arthritis

  • decrease platelet function
224
Q

Anaphylactoid reaction

A

severe non-immune mediate reaction

  • inflammatory mediators released from mast cells and basophils
225
Q

Most common organ injured in penetrating trauma

A

liver

226
Q

most common organ injured in blunt trauma

A

spleen

227
Q

portal triad

A

portal vein, hepatic artery, and common bile duct

228
Q

What are leukocyte reduced red blood cells used for?

A

For patients with previous febrile transfusion reactions

229
Q

Which blood component has the greatest risk of transmission of infectious disease?

A

platelets

230
Q

storage defects that occur in stored blood

A
  • decreased
    • pH
    • 2,3 DPG
    • ATP
    • glucose
    • clotting factors V and VIII
  • increased
    • potassium
    • phosphate
231
Q

decreased reticulocyte count

A

inability of the body to produce RBCs

232
Q

Common causes of prolonged PTT

A

Hemophilia A and B and von Willebrand’s

233
Q

common cause of prolonged PT

A

vitamin K deficiency

234
Q

common cause of prolonged PT and PTT

A

heparin and Coumadin

235
Q

Common causes of Thrombocytopenia

A

H.I.D.

  • hypersplenism
  • idiopathic thrombocytopenia purpura
  • drugs, dilutional, DIC
236
Q

common causes of inhibited platelet function

A
  • aspirin
  • uremia
  • von Willebrand’s disease
237
Q

If one blood volume has been transfused, about _____ of platelets will be lost

A

65%

238
Q

Normal PT

A

12 - 14 sec

239
Q

Normal PTT

A

25 - 35 sec

240
Q

Normal INR

A

1 - 1.2

241
Q

Which procoagulant is not synthesized in the liver?

A

Factor 8

synthesized in the reticuloendothelial system

242
Q

Hemophilia A

A

factor 8 deficient

243
Q

Hemophilia B

A

factor 9 deficient

treat with recombinant factor 9 or FFP

244
Q

von Willebrand’s disease

A

decreased factor 8 and a protein for platelet function

245
Q

How is vonWillebrand’s disease treated?

A

Factor 8 concentrate (Humate P) orDDAVP

Cryoprecipitate can also be used but is less efficient

246
Q

DDAVP

A

synthetic analogue of vasopressin

temporarily increases factor 8 and vWF complex by increasing their release from endothelial cells

247
Q

HOCM

A

Hypertrophic Obstructive Cardiomyopathy

248
Q

Hypertrophic Obstructive Cardiomyopathy

A

severe hypertrophy of the myocardium.

  • intraventricular septum moves towards the mitral valve during systole causing LV outflow obstruction
249
Q

most common cause of sudden cardiac death in young athletes

A

Hypertrophic Obstructive Cardiomyopathy

250
Q

Anesthetic goals in the management of a patient with HOCM

A
  • Adequate preload
  • Maintain afterload
  • slightly decreased HR
  • avoid increased contractility and sympathetic stimulation
251
Q

What valvular disorder can result from severe HOCM and systolic anterior motion?

A

mitral regurgitation

252
Q

When should one treat Hyperkalemia?

A

over 6 mEq/L

253
Q

What are treatment options for acute Hyperkalemia?

A
  • Calcium
  • Sodium Bicarbonate
  • Beta agonists
  • Low dose epinephrine
  • Glucose and insulin
  • Hyperventilation
  • Dialysis
  • Lasix
254
Q

autonomic storm

A
  • tachycardia
  • hypertension
  • vasoconstriction
  • elevated catecholamines
255
Q

3 major parameters measured with SSEPs

A
  • Amplitude
  • Latency
  • Central conduction time
256
Q

clinically significant changes in the SSEP

A

Decrease in amplitude by 50%

Increase in latency by 10%

257
Q

Hyperbaric Oxygen Therapy

A

administration of 100% O2 above normal atmospheric pressure – usually at 2-3 atm

258
Q

methemoglobinemia

A

Fe in Hgb becomes oxidized and thus has less affinity for oxygen binding

259
Q

classic X-ray finding in epiglottitis

A

“thumb pring sign”

260
Q

How long before a neuraxial block should a patient discontinue NSAID’s

A

3 days

261
Q

How long before a neuraxial block should a patient discontinue Coumadin

A

5 days

262
Q

How long before a neuraxial block should a patient discontinue ASA or plavix?

A

7 days

263
Q

What risk factors place a patient at higher risk of hypotension after a spinal block?

A
  • obesity
  • over 40 y.o.
  • hypovolemia
  • medications like ACE inhibitors and ARBs
264
Q

location of cardioaccelerator fibers

A

T1 - T4

265
Q

CRPS

A

Complex Regional Pain Syndrome

266
Q

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?

A

6th cervical vertebrae, lateral to the cricoid, and medial to the carotid artery

267
Q

Horner’s Syndrome

A

miosis, ptosis, and anhydrosis

  • often occurs with stellate ganglion block
268
Q

how will Furosemide affect NDMB?

A

prolong effects

furosemide decreases release of ACh

269
Q

Magnesium will enhance the efficacy of both nondepolarizing and depolarizing NMBD’s. What is the mechanism?

A

blocks the prejunctional Calcium channels which decreases the release of Ach

  • Potentiation of Sux most likely due to effect of Mg on pseudocholinesterase
270
Q

Which of the volatile agents is best at enhancing the efficacy of Nondepolarizing NMBD’s?

A

Desflurane > Sevoflurane> Isoflurane> Halothane >N2O

271
Q

What is the treatment of hypermagnesemia?

A
  • Lasix
  • Calcium Gluconate 1 gm
  • Hemodialysis
  • Volume expansion
272
Q

What are the signs and symptoms of Autonomic Hyperreflexia?

A
  • Hypertension
  • Dysrthythmias
  • Bradycardia
  • Mydriasis
  • Flushing above the SCI level
  • Nasal Congestion
  • Headache
273
Q

normal cardiac index

A

2.8 - 4.2 L/min/m2

274
Q

normal stroke volume

A

60 - 90 mL/beat

275
Q

normal stroke index

A

40 - 60 mL/beat/m2

276
Q

systemic vascular resistance

A

900 - 1400 dynes*sec/cm

(MAP - CVP)/CO * 80

277
Q

normal systemic vascular resistance index

A

1900 - 2400 dynes*sec/cm5

278
Q

Pulmonary Vascular Resistance

A

100 - 250 dynes*sec/cm5

(PAP - PCWP)/CO * 80

279
Q

normal Pulmonary Vascular Resistance Index

A

45 - 225 dynes*sec/cm5

280
Q

Cerebral blood flow determinants

A
281
Q

normal cerebral perfusion pressure

A

50 - 150 mmHg

282
Q

normal cerebral blood flow

A

50 mL/100g

283
Q

normal cerebral metabolic rate

A

3.0 - 3.8 mL/100g

284
Q

cerebral blood flow increases _____ for every 1 mmHg increase in PaCO2

A

1 mL/100g/min

285
Q

in cerebral autoregulation, below 50mmHg, vessels are maximally dialted and pressure ______ flow

A

dependent

286
Q

chronic hypertension shifts the cerebral autoregulation curve to the _____

A

right

287
Q

volatile agents effect on CMRO2

A

decrease

results in uncoupling of CBF and CMRO2

288
Q

N2O and cerebral blood flow

A

less effect and does not interfere with autoregulation

  • Tension Pneumocephalus possible if nitrous oxide used after dural closure
289
Q

normal intracranial pressure

A

5 - 15 mmHg

290
Q

Intracranial Elastance Curve

A

intracranial pressure vs volume

  • patient can no longer compensate increase in intracranial volume past point 2-3
291
Q

(3) measurements of ICP

A

subdural bolt

ventriculostomy

lumbar subarachnoid catheter

292
Q

most common infratentorial tumor in adults

A

acoustic neuroma

293
Q

“Triple H” Therapyfor Cerebral Aneurysm

A

hypervolemia, hypertension, and hemodilution

294
Q

Hunt-Hess Grading System

A

classifies subarachnoid hemorrhages

  • 1 - Asymptomati
  • 5 - deep coma
295
Q

Spetzler Martin Grading

A

classifies Arteriovenous Malformations

296
Q

Parkinson’s Disease

A

degeneration of substantia niagra of the basal ganglia that decreases dopamine production

297
Q

ketamine’s effect on neuroanesthesia

A

increases CBF and CMRO2

298
Q

Propofol’s effect on neuroanesthesia

A

decreases CBF and CMRO2

299
Q

volatile agent’s effect on neuroanesthesia

A

increases CBF, but decreases CMRO2

300
Q

VP shunt

A

ventriculoperitoneal shunt

  • treatment for hydrocephalus
301
Q

gold standard for neurologic assessment during a carotid endarterectomy

A

monitoring while awake

302
Q

acute MI vs recent

A

acute - 7 day or less

recent - 7 days to 1 month

303
Q

osmolarity of normal saline

A

308

304
Q

osmolarity of lactated ringer

A

273

305
Q

osmolarity of dextrose 5%

A

252

306
Q

normal serum osmolarity

A

275- 295

307
Q

components in normal saline

A

sodium and chloride

308
Q

components in lactated ringer

A

sodium, chloride, potassium, calcium, and lactate

309
Q

components in dextrose 5%

A

50 g/L glucose

310
Q

JCAHO

A

Joint Commission on the Accreditation of Healthcare Organizations

311
Q

OSHA

A

Occupational Safety and Health Administration

312
Q

HIPAA

A

Health Insurance Portability and Accountability

313
Q

How to determine if a baby is dehydrated

A

sunken fontanelles

314
Q

normal platelet count

A

150k - 400k

315
Q

normal glucose level

A

70 - 110 mg/dL

316
Q

Metoclopromide

[contraindications]

A

Parkinson’s, Alzheimer’s, and bowel resection

317
Q

Most common nerve injury from positioning

A

ulnar

(Peroneal if in lithotomy)

318
Q

Where does the spinal cord end?

A

L1 - L2

(L3 in children)

319
Q

TURP

A

Trans-Uretheral Resection of the Prostate

320
Q

(5) Causes of Hyperthermia

A
  • thrombophlebitis
  • urinary tract infection
  • atelectasis or aspiration
  • wound infection
  • wonder drugs (cocaine, amphetamines)
321
Q

Shivering increases oxygen consumption by _____%

A

400-500%

322
Q

Droperidol

[dose]

A

0.02 - 0.03 mg/kg

323
Q

Ondansetron

[mechanism of action]

A

5-HT3 antagonist

324
Q

Metoclopromide

[dose]

A

10 mg

325
Q

Reasons that patient can’t awaken

[SOAP]

A
  • Stroke
  • overdose
  • acidosis/alkalosis
  • paralysis
326
Q

most common reason of inadequate reversal of non-depolarizer

A

hypothermia

327
Q

Hypotension Diagnosis

[TED FARIOS]

A
  • Temperature
  • embolus
  • drugs
  • fluid deficiency
  • anesthesia too deep
  • rhythm problem
  • inotropy problem
  • oxygen deficiency
  • surgical compression
328
Q

spinal

[layers of advancement]

A
  • skin
  • sub-q
  • supraspinous ligament
  • interspinous ligament
  • ligamentum flavum
  • epidural space
  • dura/arachnoid
329
Q

normal BUN

A

10 - 20 mg/dL

330
Q

surgical procedure to correct a hernia

A

herniorraphy

331
Q

TURBT

A

Trans-Urethral Resection of Bladder Tumor

332
Q

relocation of balls

A

orchiopexy

333
Q

Diabetic Ketoacidosis

A

accumulation of ketone acids due to lack of insulin

  • Type I diabetes
334
Q

ALS

A

Amyotropic Lateral Sclerosis

335
Q

Amyotropic Lateral Sclerosis

A

aka Lou Gehrig’s disease

  • progressive loss of motor function
  • asymmetric weakness of limbs
  • avoid succinylcholine
  • increased sensitivity to NDMR
336
Q

Multiple Sclerosis

A

demyelinating process of brain and spinal cord

337
Q

Guillian-Barre Syndrome

A

polyneuropathy of motor, sensory, and autonomic nerves

  • ascending muscle weakness
    • (ground to brain)
  • avoid succinylcholine
  • hypersensitive to NDMR
338
Q

Myasthenia Gravis

A

auto-immune disease of neuromuscular junction

  • descending
  • symptoms improve with rest
339
Q

Eaton-Lambert Syndrome

A

autoimmune disorder of neuromuscular junction associated with carcinomas

  • Myasthenic syndrome
  • muscle weakness not improved with anti-cholinesterases
340
Q

Fat Embolus

[(5) diagnosis]

A
  • tachycardia
  • hyperthermia
  • urinary fat globules
  • decreased platelets
  • DIC
341
Q

Tourniquet

[pressure]

A

100 mmHg above systolic for lower extremities

50 mmHg above for upper extremities

342
Q

surgical removal of the thymus

A

Thymectomy

343
Q

ERCP

A

Endoscopic Retrograde Cholangio-Pancreatography

344
Q

repair of an abnormal opening in the diaphragm allowing abdominal organs to migrate into chest wall

A

Diaphragmatic Hernia Repair

345
Q

Thyroid Storm

[management]

A
  • propylthiuracil
  • hydrocortisone
  • digoxin
  • propanolol
  • acetaminophen
  • Na Iodide
  • IV fluids
  • cooling blankets
346
Q

What hormone does the adrenal cortex produce?

A

mineralcorticoids (aldosterone)

corticosteroids

glucocorticoids (cortisol)

androgens

347
Q

posterior pituitary

[hormone secretion]

A

vasopressin and oxytocin

348
Q

SIADH

A

Syndrome of Inappropriate Anti-Diuretic Hormone

349
Q

Mediastinoscopy

[monitors]

A

pulse ox or arterial line on right hand to detect compression of innominate artery

350
Q

Triple H Therapy for Cerebral Vasospasm

A

hypervolemia, hypertension, and hemodilution

351
Q
A

Comprehensive Exam (6 decks)

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