BB final review

Question 1

CV changes in the elderly

Answer 1

Decreased elasticity in the arteries
Decreased HR
Decreased baroreceptor response
Increased afterload, systolic pressure

Question 2

In the elderly, IV induction is ____, and ihnhaled induciton is ___

Answer 2

Slower
Faster
(Due to slower circulation time)

Question 3

2 CV responses that are altered d/t bulnted B receptor response

Answer 3

Decreased max HR
Decreased peak EF

Question 4

The EF of an alederly patient is more dependent on ___

Answer 4

LVEDV over HR
Makes them prone to CHF

Question 5

Respiratory changes in the elderly

Answer 5

Decreased elasticity, alveolar surface area, cough, response to hypoxia and hypercarbia, RLC, DS,
Increased RV, CC, CV
VQ mismatch

Question 6

GI changes in the elderly

Answer 6

PH rises
Gastric emptying slows
Smaller stomach

Question 7

What is the most specific test for renal failure?

Answer 7

Cr Clearance to assess GFR

Question 8

MAC for the elderly decreases __ per decade after age ___

Answer 8

4%
40
I thought 7?%?

Question 9

How is albumin and AAG effected in the elderly?

Answer 9

Lower albumin
AAG increases- this binds LA and opioids

Question 10

What is the functional unit of the liver?

Answer 10

Lobule

Question 11

Acinus, zones of it

Answer 11

Relevant to hepatic fx
Zone 1- oxygen and nutrient gradients
Zone 3- highest concentration of cyp450

Question 12

What are kupffer cells

Answer 12

Remove bacteria from blood before it enters the vena cava
Large bacterial load

Question 13

The ___ is responsible for about half of lymph production in the body

Answer 13

Liver

Question 14

Blood flow to the liver

Answer 14

Portal vein- 75% blood flow, 50% O2
Hepatic artery- 25% blood flow, 50% O2

Question 15

Is the portal vein autoregulated?

Answer 15

No
Depends on SNS, pain, hypoxia, hypercarbia

Question 16

Portal HTN S&S

Answer 16

Splenomegaly
Varicies of the esophagus
Stomach
Intestine

Question 16

Normal portal vein pressure, and pressure needed for portal HTN diagnosis

Answer 16

7-10mmHg
>20mmHg

Question 17

Hepatic artery flow formula

Answer 17

HAPP= MAP= HVP

Question 18

Severe liver disease ____ the arterial buffer response to decreased blood flow

Answer 18

abolishes

Question 19

Where does protein synthesis occur?

Answer 19

Liver

Question 20

How are liver pts affected when given Succ?

Answer 20

Prolonged effects d/t decreased plasma cholinesterases

Question 21

How do the elderly respons to NMBs?

Answer 21

No change in effects
Prolonged excretion

Question 22

LFTs

Answer 22

Synthetic production- albumin, PT
Hepatocyte injury- AST, ALT
Biliary duct obstruction- 5-Nucelo
Hepatic clearance- Bilirubin

Question 23

Anesthetic considerations for liver patients

Answer 23

Use iso or sevo, no des or halothane
No peep
Normocapnia
RA is ok if no coag defectrs

Question 24

What drugs are hepatotoxic?

Answer 24

Acetaminophin
Halothane
Amio
ABX- PCN, tetracyclines, sulfa

Question 25

Drug induced hepatitis can be caused from

Answer 25

Acetaminophen
Alcohol- most common drug
Halothane- immune mediated

Question 26

Treatment of alcohol withdrawal

Answer 26

Alcohol
BBs
Alpha 2 agonists

Question 27

Tx and S&SW for delerium tremens

Answer 27

Diazepam
BBs
Grand mal seizures, halucinations, nightmares, tachy, htn, n/v, confusion

Question 28

S&S cholecystitis

Answer 28

Inflammation of gallbladder or cystic duct
Murphy sign- pain on inspiration
Fever, jaundice, RUQ pain

Question 29

Surgical management of GERD

Answer 29

Nissen fundoplication