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Comprehensive exam Spring 21 (retake) > Basic exam 2 > Flashcards

Basic exam 2 Flashcards

1
Q

Lactic acidosis due to hypoperfusion should be treated with what before administering bicarbonate? CHOOSE 2

A

Fluid resuscitation

Oxygen

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2
Q

A positive base excess indicates what acid base disturbance?

A

Metabolic alkalosis

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3
Q

What happens to your CO and oxyhemoglobin curve in metabolic alkalosis

A

Decrease CO and Left shift in oxyhemoglobin dissociation curve

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4
Q

Where is there high ventilation but no perfusion (dead space)?

A

Trachea

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5
Q

What are the signs and symptoms of nerve damage in the lateral recumbent position?

A

Brachial plexus- burning sensation and weakness in arm and hand

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6
Q

What physiological changes would you expect to see in a pt. who is in the lateral recumbent position? (think HR and MAP)

A

Increase in HR from 85 to 97 and Decrease in MAP

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7
Q

How would you prepare a pt to prevent ulnar nerve damage in the supine position? (2 answers)

A

Avoid excessive pressure on the post condylar groove of the humerus

hand and forearm position will need to be either supinated and/or in the neutral position.

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8
Q

What physiological change happens in your body at first when you are put in trendelenburg?

A

1 Min: 9% increase in Cardiac Output, 10 Min: C.O. returns to baseline

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9
Q

Compression or stretch injury to the ____________is common in Trendelenburg positions

A

Brachial plexus

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10
Q

When in prone position and your arms are up by their head, your shoulders should be?

A

less than 90 degrees

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11
Q

While the patient is in the prone position, proper padding and rotation of the arms is essential for prevention of what major nerve complication?

A

ulnar nerve compression

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12
Q

Invasive arterial blood pressure should be monitored at what level in the sitting position?

A

External auditory meatus to optimize cerebral perfusion pressure

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13
Q

As a SRNA you are well aware of the risk factors associated with the sitting position, so when your patient develops a venous air embolism, you remain calm and do the following. Select all that apply

A

a. Discontinue N2O immediately and deliver 100% oxygen with anesthetic inhalation
b. Attempt to aspirate central venous catheter to retrieve entrained air
c. Implement Bilateral jugular vein compression

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14
Q

Risk with sitting position?

A

Venous air embolism

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15
Q

How much blood can a lap hold?

A

100-150ml

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16
Q

How much blood can a 4 x 4 hold?

A

10ml

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17
Q

Formula for Allowable Blood loss?

A

EBV x (starting Hct – Target Hct)/ Starting Hct

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18
Q

Your pH is 7.21, CO2 47, HCO3 31, what is this blood gas?

A

Partially compensated respiratory acidosis

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19
Q

What are the 2 most common physiological complications of Spinal?

A

bradycardia

hypotension

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20
Q

Two causes of cardiac arrest during a spinal?

A

increased vagal response

decreased preload

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21
Q

Metabolic Acidosis and an anion gap <12 (normal) may be indicative of what disorder?

A

HYPOaldosteronism

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22
Q

Renal compensation during metabolic acidosis includes?

A

a. Increased reabsorption of filtered HCO3
b. Increased ammonia production
c. Increased excretion of acid

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23
Q

PACO2 increases appx ____ hg for each ___ meqs increase in HCO3?

A

1 : 1

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24
Q

Does Malignant hyperthermia cause respiratory alkalosis?

A

MH is a cause of respiratory ACIDOSIS

mixed respiratory and metabolic acidosis

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25
Q

Patient with respiratory rate of 32. Complaining of dyspnea and has a K+ of 5.9 and a history of COPD. Without ABG, what would you expect?

A

Respiratory acidosis

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26
Q

Respiratory alkalosis can be controlled during neurosurgery to decrease ICP, but PaCO2 ____mmHg may produce cerebral ischemia

A

below 20

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27
Q

Hanging 12th bag of PRBCs on trauma patient. What acid base imbalance would you expect?

A

Metabolic acidosis

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28
Q

You are giving blood, what’s the proper identification?

A

Right patient, drug, dose, route, time.

Check with a licensed provider.

Check pt armband.

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29
Q

Pituitary gland tumor (pituitary adenoma) = Cushing’s syndrome, what does this tumor secrete and cause an increase in?

A

Secretes excess amount of ACTH

Increased cortisol from adrenal glands

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30
Q

Most common type of Villous adenoma?

A

Tubular

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31
Q

Adrenal adenoma can produce what syndrome?

A

Cushing’s

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32
Q

cushing’s syndrome is caused by excessive levels of what?

A

Cortisol

33
Q

Preoperative preparation of Cushing’s syndrome includes the initial treatment of what three things?

A

treatment of hypertension
DM
and creating a normal fluid volume

34
Q

Decrease in sodium reabsorption and the loss of potassium and hydrogen ions is characteristic of what?

A

Excessive secretion of aldosterone

35
Q

What is the principle site of action of aldosterone?

A

distal nephrons

36
Q

The principal regulators of aldosterone synthesis and secretion is what two things?

A

Renin-angiotensin system

potassium ion concentration

37
Q

Major circulating mineralocorticoid in the human body?

A

ALDOSTERONE

38
Q

Made exclusively in the Zona glomerulosa?

A

Aldosterone

39
Q

What are the five body buffer systems when talking about acid base balance?

A 
Bicarbonate
Hemoglobin
Intracellular proteins
Phosphates
Ammonia
40
Q

Most important NONCarbonic buffer in the extracellular fluid?

A

Hemoglobin

41
Q

What line of defense describes the kidneys ability to retain and excrete bicarbonate, synthesize ammonia and eliminate potassium ions?

A

3rd line defense

42
Q

Which line of defense acts within minutes has max effect in 12-24 hours. H2CO3 produced and converted to CO2 for elimination?

A

2nd line defense

43
Q

H2CO3 produced and converted to CO2 for elimination. Increase in alveolar ventilation describes what line of defense?

A

2nd line defense

44
Q

An increase in H+ ions or more acidity would result in an increase or decrease in pH?

A

Decrease in pH

45
Q

Sick patient using a Wilson table for surgery, what is a postoperative complication for this patient?

A

Postoperative vision loss

46
Q

How do you position a patient having a Laminectomy?

A

Place patient with their arms close to their side while in the prone position.

47
Q

What drug could distinguish between MH and NMS?

A

Rocuronium

48
Q

What Respiratory changes would you see with hyperthermia in an anesthetized patient (choose 2)?

A

Increased minute ventilation
Increased CO2

also:
Tachycardia
Hypertension
Increased drug metabolism
Dehydration (decreased U/O)
Increased O2 consumption
49
Q

40% of heat loss in the OR is due to?

A

Radiation

50
Q

Hypothermia does what to the dissociation curve, and what to O2 consumption?

A

Left shift of the hemoglobin- dissociation saturation curve

increases O2 consumption up to 300%

51
Q

Shivering? (tell me two things)

A

May increase oxygen consumption up to fivefold

associated with myocardial ischemia

52
Q

Patients at risk for hypothermia?

A

May be as frequent as 65% with GA

male gender

53
Q

85 y/o uroseptic patient getting 11th unit of blood, what would you expect could happen?

A

Citrate intoxication from blood administration

54
Q

Ratio of crystalloids to blood loss?

A

3x the crystalloid to the blood loss

1:3

55
Q

How do you calculate adequate urine output?

A

0.5-1 ml/kg/hr

56
Q

Universal blood donor?

A

O-

57
Q

Rarest blood type?

A

AB-

58
Q

Most malignant hyperthermia deaths are due to? (2)

A

Organ failure

Delay in dantrolene treatment

59
Q

What order of malignant hyperthermia indications would you expect to see in the clinical setting?

A

Masseter muscle rigidity, Increased end tidal co2, Increased temperature

60
Q

8 year old child, what would be their tubes size and cut length?

A

tube size = 5.5, 6, 6.5 (mm)

cut length = 18cm

61
Q

A 28 year old woman undergoing surgery and is anesthetized with an inhalant and she is also given iv succ. She develops a HR of 129, increased co2 and a rising temp. This is due to?

A

Interferes with the release of calcium from the sarcoplasmic reticulum

(Malignant hyperthermia)

62
Q

After receiving a spinal, nausea would be due to? (Choose 2)

A

Systemic hypotension that would be sufficient enough to produce cerebral ischemia

Predominance of the parasympathetic activity due to the sympathetic nervous system being selectively blocked

63
Q

What things about the needle used could lower the incidence of post procedure HA? (2)

A

25 gauge needle (small)

A pencil pointed needle

64
Q

t4
t6
t10
dermatome levels?

A

nipple
xyphoid
umbilicus

65
Q

What is a drug we use with paralytics that causes N&V?

A

Neuromuscular-blockage reversal (neostigmine)

66
Q

68kg person, what size LMA?

A

4

67
Q

Pseudocholinesterase deficiency, what drug do you take out of your induction line up?

A

Succinylcholine

68
Q

Blood volume of …
infant
full term
preterm

(what is the ml you x the kg by)

A 
80ml = infant
85ml = full term
95ml = preterm
69
Q

How do you calculate adjusted body weight?

A

ABW = (IBW + Actual Body Weight) / 2

70
Q

MOA of Dantrolene?

A

interferes with release of calcium from SR at ryanodine receptor

71
Q

Elevated anion gap is most likely caused by?

A

ketoacidosis

72
Q

How much does a patient’s temperature decrease in the first hour when you do not attempt to warm an anesthetized patient?

A

1-2 degrees C during the first hour

73
Q

Dantrolene dosing?

A

2-10mg/kg

half life is 6 hours thus q6hr give 1mg/kg for 24 hours

74
Q

What blood gas would you see when minute ventilation is insufficient to eliminate CO2 production without an increased capillary-alveolar CO2 gradient

A

Respiratory Acidosis

75
Q

common reasons for a patient to be in respiratory acidosis? (2) (one is the patient, one is the machine)

A

A patient with COPD

Exhausted soda lime

76
Q

Why is Neo preferred when you want to keep HR the same and increase BP?

A

Pure alpha agonist (alpha 1)

77
Q

earliest sign of MH, and MOST sensitive sign of MH?

A

MMR

CO2 doubling or tripling

78
Q

Lab (blood gas) you would expect to see with MH?

A

TYPICALLY HAVE MIXED METABOLIC AND RESPIRATORY ACIDOSIS WITH MARKED BASE DEFICIT.
MAY HAVE EARLY ISOLATED RESPIRATORY ACIDOSIS

Comprehensive exam Spring 21 (retake) (5 decks)

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