Apex Exams Missed Questions And Rationale Flashcards
Torsades des pointes is Most likely to occur following administration of what narcotic
Methadone- only narcotic known to prolong the QT interval
Hepatic function tests and their baisis of abnormality
Synthetic function- PT, INR, Albumin
Hepatocellular injury- AST, ALT, GST
Cholelithiasis- alkaline phosphate, GGTP(more specific)
Complications of celiac plexus block
Used for blocking abdominal organs in cancer patients or those going under for abdominal surgery who cannot receive spinal
Complications- hypotension (most common), bowel puncture, retroperitoneal bleeding, diarrhea, and paralysis.
Functional group of Amine, Alcohol, Ether, Ester
Amine- NR3
Alcohol-ROH
Ether-ROR’
Ester-RCOOR
Law of laplace
Tension= pressure x radius
Abdominal aneurysm more likely to rupture during hypertension
Poiseuills law
Flow is directly proportional to the radius to the fourth power and the pressure difference along the tube. Flow is inversely proportional to viscosity and the length of the tube.
Describes laminar flow through a tube
Bernoullis principle
Describes flow through a constriction. At the site of the constriction the fluids velocity increases, creating a pressure drop at the constriction.
How long to postpone elective surgery for a pt who just had a drug eluting stent or bare mental stent placed
Drug eluting- 6 months
Bare metal stent-30 days
Mannitol dosing
Inhibits water transportation at the loop of Henle
0.25-1 g/kg.
Dorsal respiratory center, central respiratory center, amnesties center, and pneumotaxic centers. Where are the found and what do they do
All are a part of the reticular activating system in the pond or medulla.
Dorsal- found in medulla, inspiration pacemaker
Ventral- found in medulla, causes active exhalation
Apneustic- found in pons and stimulates DRC triggering inhalation
Pneumotaxic- found in pons and inhibits DRC triggers the end of inhalation
Cerebral blood flow is directly proportional to PaCO2 by how much
For every 1mmHG change in PaCO2 from 40mmHG, CBF changes in the same direction by 1-2ml/100g/min
Drugs that interfere with SSEP monitoring
SSEP monitors integrity of dorsal (sensory) but not ventral (motor) region of spinal cord.
Drugs - volatile anesthetic, nitrous oxide, propofol, barbiturates, midazolam, and diazepam.
Drugs that do not- ketamine, precedex, etomidate, opioids, and droperidol.
Near infrared spectroscopy measures cerebral-
Venous oxygen saturation, only measures venous o2 in prefrontal cortex and is not a suitable monitor for global ischemia
Drugs that can precipitate carcinoid crisis in patient with carcinoid tumors
Succs, atracurium, thiopental, epinephrine, norepinephrine, isoproterenol.
Presents as intense flushing, diarrhea, abdominal pain, tachy, hypertension, or hypotension.
Zofran, and octreitide are useful in management of these pts. No volatile anesthetics affect this.
Afferent and efferent limbs of oculocardiac reflex and comprised of-
Afferent- long and short ciliary nerves, ciliary ganglion, ophthalmic division of trigeminal nerve, gasserian ganglion.
Efferent- vagus nerve and SA node.
Treatment of reflex includes removing stimulus, 100% O2, and anticholinergic (atropine or glyco)
Most common cause of perioperative allergic reactions
Muscle relaxants (50-60%)
Latex (15%)
Antibiotics (10-15%)
Less common (less than 2-3%) protamine, hypnotics, colloids, opioids, contrast, blood, local anesthesia.
Causes of early, late, and variable fetal heart rate decelerations
Early- uterine contractions compress head
Late- decrease uteroplacental perfusion, maternal hypotension, hypovolemia, acidosis, preeclampsia.
Variable- umbilical cord compression- causes baroreceptor mediated decrease in FHR. Urgent assessment of fetus
findings for primary hyperparathyroidism
Hypersecretion of PTH leads to increased Ca2. Symptoms at 12mg/dl
HTN, short QT, hypotonia, kidney stones, polyuria, dehydration, bone pains, NV, abd pain, pancreatitis, cognitive dysfunction.
List types of cutting, pencil point, and bevel tip spinal needles
Cutting- quinke, pitkin- increase risk of PDPH
Pencil- sprotte, pecan, Whitaker, lower risk of PDPH
Bevel- Greene lower risk of PDPH
Calcium channel blocker that reduces mortality in pt with cerebral vasospasm
Nimodipine- only calcium channel blocker to improve outcomes.
BmI calculation
Weight in Kg / height in meters squared= BMI
What contusions are associated with gastroschisis/ omphalocele
Gastroschisis- prematurity. Usually occurs to right of unbillicus, not covered by hernia sac.
Omphalocele- midline defect covered by hernia sac, associated with beckwith-Weidmann, congenital heart disease, trisomy 21, etc.
Neuromuscular test and % receptors still occupied
TOF 4\4, Tidal volume 5ml/kg, bite on tounge blade more than 5 seconds, double burst without fade
TOF 4/4- 70%
Tidal volume 5ml/kg- 80%
Bite on tounge blade - 50%
Double burst- 60%
Losartan increases what
Increases lithium reabsorbtion , increases maternal and fetal mortality, increases serum potassium.
Oral angiotensin 2 receptor antagonist. Combats hypertension, but does not affect Angiotensin converting enzyme. Can cause post-induction hypotension, will respond to vasopressin or methylene blue
Glucagon effects
Antagonizes affects of insulin- raises blood sugar by gluconeogenesis in liver, produced by alpha cells in pancreas (insulin produced by beta cells), increase myocardial contractility by increasing cAMP inside cardiac myocite. Useful in beta-blocker overdose, chf, low CO in MI or CPB pts.
Nausea and vomiting is side effect.
Cvp monitoring in pneumonectomy pt
CVP line should be placed on operative side (risk of pneumothorax), IJ over EJ line, CVP in not a necessity for routine cases, increased filling pressure predispose lung to injury.
Location of ST abnormality and the monitors
Right coronary artery monitored by lead 2, 3, and aVF. Supplies RA, RV, Sa+AV nodes, and inferior aspect of LV
Left coronary divides to left anterior descending LAD and circumflex artery Cx
LAD- V3-V5, anterolaterak region of LV
Circumflex- 1 and AVL. Lateral aspect of LV
Max time of spinal hematoma before surgical decompression
8 hours
Anes. Consideration for pt with pheochromocytoma
Catecholamine secreting tumor (NE) presents as excessive SNS activation (headache, diaphoresis, and tachycardia)
Must alpha block before beta block
Phenoxybenzamine before labetolol
Nitroprusside decreases SVR and decreases BP safely, have dextrose available once tumor is removed- leaded to hypoglycemia.
Recommend bladder width of blood pressure cuff
40% circumstance of extremity
Cuff to small with give high reading
Cuff to big will give low reading
Cardioversion of a fib, flutter, av node re-entry, or tachycardia secondary to preexcitation syndrome
First shock at 50-100 joules then increase incrementally to 360
Need to use synchronized shock to the R wave
Equation for MAP
MAP=(SBP X 1/3) + (DBP X 2/3)
Systolic accounts for 1/3 of cardiac cycle and diastolic accounts for 2/3 of cardiac cycle
Conditions that warrant antibiotic prophylaxis for infective endocarditis when undergoing tooth extraction
Previous infective endocarditis, prosthetic heart valve/repair, heart transplant with valvuplasty, unrepaird cyanotic congenital heart defect, dental procedure with gingival manipulation, and resp procedure with perforation to mucosal lining.
