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Clinical Entrance Exam > Basics exam 2 > Flashcards

Basics exam 2 Flashcards

1
Q

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

A
  1. fluid resuscitation

2. oxygen

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2
Q

A positive base excess indicates what acid base disturbane?

A

Metabolic alkalosis

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3
Q

What is the correct formula for administration for bicarbonate (dose calculation) :

A

Dose of sodium bicarbonate=body weight (kg) X deviation of plasma bicarbonate concentration from 24 mEq/L X extracellular fluid volume as a fraction of body mass (0.2

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4
Q

What disease involves the renin-angiotensin system and potassium ion concentration.

A

hyperaldosteronism

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5
Q

What disease is characterized by increased reabsorption of Na+ and loss of potassium and H+ ions?

A

hyperaldosteronism

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6
Q

A decrease in CO and a left shift in the oxyhbg dissociation curve can be associated with what metabolic state?

A

metabolic alkalosis

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7
Q

In metabolic alkalosis, which direction would you see the oxyhbg dissociation curve shift?

A

left

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8
Q

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

A

trachea

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9
Q

What are the s/s of nerve damage in the lateral recumbent position?

A

Brachial plexus - burning sensation and weakness in arm and hand

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10
Q

What physiological changes would you expect to see in a pt who is in the lateral recumbent position?

A
  • Increase in HR (85 to 97)
  • Decrease in MAP

*dr. hammon accepted both

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11
Q

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

A

1-Avoid excessive pressure on the post condylar groove of the humerus
2- Hand and arm position will need to be either supinated and/or in the neutral position.

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12
Q

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

A
  • 1Min: 9% increase in CO

- 10min: CO returns to baseline

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13
Q

Compression or stretch injury to the ______ is common in Trendelenburg position.

A

Brachial plexus

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14
Q

When in prone position and your arms are up by the head; your shoulders should be :

A

< 90 degrees

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15
Q

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

A

Ulnar Nerve Compression

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16
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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17
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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18
Q

Major Risk for sitting position:

A

Venous Air Embolism

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19
Q

Formula for EBV =

A 
Female = 65ml x kg
Obese = 70ml x kg
Male = 75 ml x kg
Infant = 80ml x kg
Full Term = 85ml x kg
Preterm = 95ml x kg
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20
Q

Volume associated with a surgical lap:

A

100-150ml

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21
Q

volume associated with a 4x4:

A

10ml

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22
Q

What sources of loss to you look to for calculating EBL?

A
  • Laps
  • 4x4’s
  • Suction canisters
  • blood on floor/drapes, etc
  • subtract irrigation
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23
Q

How would you know if the suction canister is all blood loss?

A

ask the circulator /tech how much irrigation was used

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24
Q

Formula for ABL =

A

[EBV x (starting HCT - Target HCT)] / Starting HCT

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25
Q

When would you give blood?

A

Blood loss greater than 30%

*15% is strongly suggested

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26
Q

What are the steps to checking blood?

A

5 Rights

  1. check pt
  2. check band/s
  3. check blood
  4. consent?
  5. verify with 2nd licensed professional
  • dilute with fluids, warm, 170mcg filter?
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27
Q

ABG Interpretation:

pH: 7.21
CO2 47
HCO3: 31

A

Partially compensated respiratory acidosis

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28
Q

You have lost 300ml of blood. You have 20 4x4 sponges soaked and 10 lap sponges soaked.

What is your EBL?

A

1500ml (or between 1500-2000ml)

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29
Q

What are the 2 most common physiological complication of a Spinal?

A

Bradycardia

Hypotension

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30
Q

Two causes of cardiac arrest in a spinal (2):

A
  1. increased vagal response

2. Decreased Preload

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31
Q

Metabolic acidosis and an anion gap <12 (normal) may be indicative of:

A

hypo-aldosteronism

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32
Q

Renal Compensation during metabolic acidosis includes: (3)

A
  1. Increased reabsorption of filtered HCO3
  2. increased ammonia production
  3. increased excretion of acid
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33
Q

PaCO2 increases approximately ___ for each ____ increase in HCO3?

A

1:1

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34
Q

Which of the following could be a case of respiratory acidosis?

A

Malignant Hyperthermia

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35
Q

Patient with RR of 32, complaining of dyspnea and has a K+ of 5.9 and a hx of COPD. Without an ABG, what would you expect?

A

Respiratory Acidosis

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36
Q

Respiratory alkalosis can be controlled during neurosurgery to decrease ICP. A paCO2 of ____ may produce cerebral ischemia.

A

< 20mmHg

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37
Q

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

A

metabolic alkalosis

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38
Q

Pituitary gland tumor (pituitary adenoma) is associated with what disease?

A

Cushing’s syndrome

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39
Q

Pituitary gland tumor (pituitary adenoma) is associated with Cushing’s syndrome. What two consequences result:

A
  • Secretes excess amount of ACTH

- Increased cortisol from adrenal glands

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40
Q

Most common villous adenoma:

A

tubular

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41
Q

What disease can result from an adrenal adenoma?

A

cushing’s syndrome

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42
Q

Excessive level of cortisol is responsible for:

A

cushing’s syndrome

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43
Q

Preoperative preparation for a pt with cushing’s syndrome includes:

A
  • tx of htn
  • dm
  • normal fluid volume
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44
Q

Excessive secretion of aldosterone is characterized by:

A

increase in sodium reabsorption and the loss of potassium and hydrogen ions

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45
Q

The principle site of action of aldosterone is:

A

the distal nephron

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46
Q

The principle regulator of ____ synthesis and secretion are the renin-angiotensin system potassium ion concentration

A

aldosterone

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47
Q

Where is aldosterone exclusively produced?

A

Zona glomerulosa of the adrenal cortex

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48
Q

What is a major circulating mineralocorticoid in the human body?

A

aldosterone

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49
Q

Name three body buffers:

A
  1. ammonia
  2. hemoglobin
  3. intracellular proteins
50
Q

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

A

third line defense

51
Q

Which line of defense acts within minutes and its max effect is within 12-24 hours. H2CO3 is produced and converted to CO2 for elimination:

A

2nd line defense

52
Q

H2CO3 produced and converted to CO2 for elimination. Increase in alveolar ventilation.

A

2nd line defense

53
Q

Identify the Henderson-Hasselbach equation:

A

pH = pKa + log {A-} /

{HA}

54
Q

A decrease in pH would result in: (2)

A
  1. increase H+ ions

2. More acidity

55
Q

Wilson table is used for patient. A post-op complication risk for this patient would include:

A

postop vision loss

56
Q

Laminectomy patient positioning:

A

Prone position. Place arms close to their side.

57
Q

What drug could be used to distinguish b/w MH and NMS?

A

Rocuronium

58
Q

What would you expect to see with hyperthermia (2)?

A
  • Increase MV

- Increased CO2

59
Q

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

A

radiation loss

60
Q

Hypothermia would shift the oxyhgb -dissociation curve in which direction?

A

Left

61
Q

Hypothermia would increase the consumption of what? by how much?

A

Oxygen consumption up to 300%

62
Q

Shivering may increase Oxygen

A

consumption up to five fold

63
Q

Shivering is associated with

A

Myocardial Ischemia

64
Q

Patients at risk for hypothermia : (2)

A
  1. male gender (not female)

2. may be as frequent as 65% with GA (not 50%)

65
Q

What gender is at greater risk for hypothermia with GA?

A

Male

66
Q

Hypothermia may be as frequent as ___ % with GA?

A

65%

67
Q

85 yo uroseptic patient is getting 11th unit of blood. What would you expect could happen?

A

Citrate intoxication from blood administration

*metabolic alkalosis , dilutional thrombocytopenia, diultional coagulopathy

68
Q

85 yr in OR lost 500ml of blood. What is crystalloid replacement rate in second hour?

A

1500ml (3:1 replaement)

69
Q

NPO Deficit formula =

A

NPO deficit= hourly maintenance rate x hours NPO

70
Q

Maintenance Rate Calculation =

A

4,2,1 rule

or + 40 to pt wt in kg

71
Q

Hourly output formula =

A

0.5-1ml/kg/hr

72
Q

IBW formula =

A

100lbs for first 5ft
Females + 5lbs /inch
Males + 7lbs/ inch

  • obesity 20% above IBW
  • Morbid obesity= twice the IBW
73
Q

5’ 3”, 45kg female. Are they at their IBW?

A 
IBW = 115lbs
ABW = 99

no, not at IBW

74
Q

Maintanance rate of a 130lbs pt:

A

99ml/hr

75
Q

Universal Donor blood type:

A

O -

76
Q

Rarest blood type:

A

AB -

77
Q

Most malignant hyperthermia deaths are due to : (2)

A
  1. Organ failure

2. Delay in dantrolene tx

78
Q

What order of MH indications would you expect to see in the clinical setting? (3)

A
  1. masseter muscle rigidity
  2. increased ETCO2
  3. Increased temp
79
Q

Little Johnny is 8 years old. What size ETT does he require?

A

Diameter: 5.5, 6, 6.5 mm sizes

80
Q

Little Johnny is 8 years old. What ETT cut length does he require?

A

18 cm

81
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

82
Q

Patient starts having dysphonia, mydriasis, weakness, and dyspnea after a spinal. What would be the next appropriate action of the SRNA?

A

prepare to intubate

83
Q

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

A
  1. Systemic hypotension that would be sufficient enough to produce cerebral ischemia
  2. Predominance of the parasympathetic activity d/t the sympathetic nervous system being selectively blocked.
84
Q

Patient has a headache after receiving a spinal. Conservative measures regarding treatment of a post dural puncture headache would include the following: (Choose two)

A
  • fluids

- 500mg caffeine

85
Q

A 25 gauge needle and A pencil pointed needle are associated with :

A

a lower incidence of post procedure headache

86
Q

T6 dermatome level:

A

xyphoid

87
Q

Neuromuscular-blockage reversal is a risk factor associated with:

A

PONV

88
Q

LMA size for 68kg pt:

A

size 4

89
Q

Adjusted Body Wt =

A

(IBW + Actual Body Weight ) / 2

90
Q

Hourly Maintanance rate for 196lbs

A 
196 = 89kg
89+40 = 129ml/hr
91
Q

ABG interpretation for :

A

Compensated metabolic acidosis

92
Q

Bupivicaine 0.75% with added epi is extended to what DOA time?

A

100-150 mins

w/o epi 90-120mins

93
Q

Respiratory Compensation in response to metabolic alkalosis and metabolic acidosis. You can adjust and anticipate corrections….

If you know HCO3 is 27, what should the pH equal?

A

pH expected to be 7.42 (HCO3 + 15)

94
Q

Differential Diagnosis associated with Hyperthermia? (3)

“conditions associated with hyperthermia (slide 34)”

A
  1. pheochromocytoma
  2. MH
  3. Thyroid Storm

*not on exam: transfusion reactions, sepsis, infection, NMS, medications, hypothalamic lesions

95
Q

Patient received a spinal but still has quite a bit of feeling remaining… What would prudent CRNA do?

A

give a second dose

  • combo of two doses should not exceed max dose
96
Q

Elevated anion gap is likely associated with:

A

Ketoacidosis (metabolic acidosis)

97
Q

MH is most common in what population?

A

Young males

98
Q

Renal compensation during metabolic acidosis does what 3 things:

A
  1. increased reabsorption of HCO3
  2. increased excretion of titratable acids (H+)
  3. increased ammonia production
99
Q

Best place to get temperature ?

A

esophagus

100
Q

How much does a patients temperature decrease in the first hour when warming is not initiated?

A

1-2 degrees Celsius in first hour

101
Q

Dantrolene dose and administration:

A

2-10mg/kg

  • 6hr half life
  • give 1mg/kg q 6h after for 24hrs
  • can cause phlebitis
102
Q

Compared to a spinal, an epidural (2):

A
  • requires 10-fold increase in the dose

- much slower onset

103
Q

A patient presents with back pain and leg weakness. What do you suspect and do?

A
  • signs of epidural hematoma

- Needs STAT CT/MRI and surgical decompression in 6-8 hrs

104
Q

Dural sac ends where in adults?

A

S2

105
Q

Occurs when MV is insufficient to eliminate CO2 production w/o an increased capillary-alveolar CO2 gradient:

A

respiratory acidosis

106
Q

(Depicts a patient with respiratory acidosis) This can commonly be seen with:

A
  • a pt with COPD

- Exhausted soda lime

107
Q

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

A

Pure alpha agonist (A1 > a2)

108
Q

Early sign of MH:

A

MMR

109
Q

Late sign of MH:

A

Hyperthermia

rises 1 degree C every 5 mins

110
Q

MH most SENSITIVE sign:

A

unanticipated doubling or tripling of ETCO2

111
Q

ABG you would expect to see with MH?

A

mixed metabolic and respiratory acidosis

112
Q

Video question:

Of 27 yr of female, hx of schizophrenia, recent d/c from psych hospital. taking haldol. Temp 101.7F, BP 157/104, HR 122, RR 24. Stiff, difficulty swallowing, remulous, diaphretic and confused. CPK is elevated. Infection negative. What is the likely diagnosis?

A

Neuroleptic malignant syndrome

113
Q

most important buffer for extracellular fluid compartment:

A

bicarbonate

114
Q

urinary buffer?

A

ammonia

115
Q

Anesthetic Implications for Alkalemia?

Respiratory alkalosis prolongs duration

A

of opioid induced respiratory depression

116
Q

Licorice Poisoning Causes

A

hypokalemia, hypernatremia, and water retention

117
Q

Cushing’s Syndrome:

A

Excessive cortisol that is produced in adrenal glands, occurs from excess production by one or both adrenal glands or overproduction of ACTH

118
Q

Hyperaldosteronism:

A
  • Aldosterone produced in zona glomerulosa,
  • major circulation mineralcorticoid in humans,
  • principal site of action of aldosterone is in the distal nephron,
  • characterized by excessive secretion of aldosterone which causes increase in sodium reabsorption and loss of potassium and hydrogen.
119
Q

Positive value base excess =

A

metabolic alkalosis

120
Q

negative value base excess =

A

metabolic acidosis

Clinical Entrance Exam (21 decks)

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