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Apex > Boot Camp Week 2 > Flashcards

Boot Camp Week 2 Flashcards

1
Q

Cross-sensitivity to latex is highest with which allergies?

A

Avocado
Kiwi
Banana and lots of other plants

But NOT shrimp or shellfish

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2
Q

What factors are associated with airway fires?

A

First case on a monday
Sevo

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3
Q

Radial nerve injury is usually caused by:

A

external pressure at the spiral groove

BY

Surgical retractor or IV pole

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4
Q

Ulnar nerve injury is usually caused by:

A

external pressure at the post-condylar groove

2/2 pronation

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5
Q

In breast cancer patients, the #1 site of metastasis is:

A

bone, leading to hypercalcemia

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5
Q

What are the MRI zones?

A
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5
Q

Nitrous tank pressure =

A

745

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6
Q

What are absolute contraindications to ECT?

A
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7
Q

What is the maximum dose of tumescent lidocaine?

A

55mg/kg

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8
Q

What is ideal BP management with a ruptured cerebral AVM?

A

Deliberate Hypotension

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9
Q

At what length does the swan enter the RV?

A

25-30

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10
Q

At what length does the swan enter the PA?

A

30-45

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11
Q

At what length is the PA usually positioned appropriately?

A

40-50

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12
Q

INCREASED pseudocholinesterase activity is associated with:

A

obesity
ETOH
Hyperthyroidism (severe)

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13
Q

DECREASED pseudocholinesterase activity is associated with:

A

Burns
Liver Disease
Malnutrition
Neoplasm
Pregnancy
Neonates

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14
Q

What are some disadvantages of tramadol?

A

Seizures
N/V
Less effective when given with zofran

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15
Q

What genetic diseases cause obesity?

A

Prader Willi
Bardet-Biedl

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16
Q

Adipose becomes pathologic when:

A

it releases excess fatty acids and cytokines

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17
Q

Class I Obesity BMI

A

30-34.9

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18
Q

Class II Obesity BMI

A

35-39.9

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19
Q

Class III Obesity BMI

A

> 40

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20
Q

Obesity definition in children

A

95th-98th percentile

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21
Q

Severe obesity definition in children

A

99th percentile

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22
Q

What are the ventilatory changes in obesity

A

FRC decreases (ERV decreases and RV remains the same)

Closing volume increases

VC decreases

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23
Q

How does obesity impact O2 consumption?

A

Fat is metabolically active, so VO2 is increased and so is CO2 production

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24
Q

Does morbid obesity mandate an RSI?

A

No, not unless there’s something else going on

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25
Q

Since Succ is water soluble, why do we dose it based on actual body weight?

A

Because obesity causes increased pseudocholinesterase activity, so a higher dose is required

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26
Q

What cardiac parameters are altered in obesity?

A

Intravascular volume is increased

CO is increased

HR is unchanged

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27
Q

How is cardiac output impacted by fat?

A

It increases by 100ml/min for every 1kg of extra fat

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28
Q

Does obesity lead to diastolic or systolic heart failure?

A

Diastolic initially

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29
Q

The Vd of which drugs is increased in obesity?

A

BOTH

Lipo: more fat
Hydro: larger muscle mass and blood volume

Lipo&raquo_space;> Hydro, but both increase

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30
Q

How do you calculate LBW?

A

IBW x 1.3

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31
Q

Vd in obese patients is altered by 4 things:

A
  1. Increased blood volume
  2. Increased CO
  3. Altered plasma protein binding
  4. Large fat mass
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32
Q

LBW is used to calculate which induction doses?

A

Prop
Roc/Vec
Remifentanil

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33
Q

Which loading doses are calculated using TBW?

A

Succ
Cis/Atracurium
Fentanyl
Sufentanil
Midazolam

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34
Q

Propofol infusions are dosed based on:

A

TBW

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35
Q

Fentanyl infusions are dosed based on:

A

IBW

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36
Q

In obese patients epidural doses should be:

A

reduced by 75%

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37
Q

What is the most sensitive sign of an anastomotic leak following gastric surgery?

A

Unexplained tachycardia

Followed by fever then abdominal pain

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38
Q

What cell signaling pathway do opioids use?

A

Decreases Adenylate cyclase -> decreased cAMP -> increased potassium conduction

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39
Q

What are the endogenous ligands for the opioid receptors?

A

Mu: Endorphins
Delta: Enkephalins
Kappa: Dynorphins

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40
Q

Which opioid receptor is responsible for bradycardia?

A

Mu

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41
Q

Which opioid receptors cause miosis?

A

Mu and Kappa

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42
Q

Which opioid receptors cause diuresis? Which cause retention?

A

Diuresis: Kappa

Retention: Mu and Delta

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43
Q

Which receptor is responsible for GI upset?

A

Mu

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44
Q

What are the mu 1 effects?

A

Supraspinal and spinal analgesia

Bradycardia
Euphoria
Low abuse potential
Miosis
Hypothermia
Urine retention

45
Q

What are the Mu 2 effects?

A

SPINAL analgesia (the spine is the second part of the CNS)
Bradycardia
Respiratory depression (2 lungs)
Constipation
Physical dependence

46
Q

What are the Mu 3 effects?

A

Immune suppression

47
Q

What are the CNS effects of Mu receptors?

A

Sedation
Euphoria
Prolactin
Mild Hypothermia

48
Q

What are the CNS effects of delta receptors?

A

None

49
Q

What are the CNS effects of kappa receptors?

A

Sedation
Dysphoria
Hallucinations
Delirium

50
Q

Which opioid receptor causes pruritis?

A

mu

51
Q

The only opioid that doesn’t reduce heart rate is:

A

meperidine, because of its atropine-like ring

52
Q

Do opioids impair the baroreceptor reflex?

A

no

53
Q

What is the mechanism by which opioids cause nausea?

A

CRTZ
Vestibular apparatus

54
Q

Sphincter of oddi pressure can be reduced by:

A

glucagon and naloxone

55
Q

Which opioids promote histamine release?

A

Meperidine
Morphine
Codeine

56
Q

Which opioid causes the LEAST oddi contraction?

A

Meperidine

57
Q

In women, morphine is associated with:

A

greater potency
Slower onset
longer duration
lower postop consumption

58
Q

Name two phenanthrene derivatives

A

morphine and codeine

59
Q

Which narcotic is a thebaine derivative?

A

Oxycodone

60
Q

Which narcotic is a piperidine?

A

Meperidine

61
Q

Which narcotic is a phenylpiperidine?

A

All of the fentanyls

62
Q

Which narcotic is a diphenylpiperidine?

A

Methadone

63
Q

Rank the fentanyls in order of potency

A

Sufentanil (10mcg)
Remi/Fent (100mcg)
Alfentanil (1000mcg)

64
Q

When does fentanyl withdrawal peak?

A

6-12 hours

65
Q

When does heroin withdrawal peak?

A

Onset 6-18 hrs
Peak 36-72 hrs

66
Q

When does methadone withdrawal peak?

A

3 - 21 days

67
Q

Remifentanil is always dosed at:

A

LBW

68
Q

What are four unique side effects of meperidien?

A
  1. Giving it with MAOs can cause serotonin syndrome
  2. Causes atropine-like effects (dry mouth, tachycardia etc)
  3. Only opioid with antishivering effect
  4. Histamine release
69
Q

What’s special about Alfentanil?

A

Rapid onset because of a pKa that’s below physiologic pH

70
Q

Which fentanyl should never be used neuraxially?

A

Remi

It has glycine in the mixture

71
Q

Methadone has three MOAs:

A
  1. Mu Agonism
  2. NMDA antagonism
  3. MAOI
72
Q

What is methadone’s active metabolite?

A

It doesn’t have one

73
Q

What is the MOA of butorphanol?

A

Mu antagonism (weak)
Kappa agonism

74
Q

What is the MOA of buprenorphine?

A

Partial Mu agonist

75
Q

What is the MOA of nalbuphine?

A

Mu Antagonism
Kappa Agonism

76
Q

Which partial agonist has an extremely high affinity for for mu receptor, making it hard to reverse?

A

Buprenorphine

77
Q

Which partial agonist is helpful with postop shivering?

A

Butorphanol

78
Q

Which antagonist does not cross the BBB?

A

Methylnaltrexone

79
Q

Which antagonist is useful in alcohol withdrawal?

A

Naltrexone

80
Q

What is the presentation of an ulnar nerve injury?

A

acute: inability to abduct 5th finger

chronic: claw hand

81
Q

What are risk factors for ulnar injury?

A

Male
Pre-existing
Extreme habitus
Prolonged stay
cardiac surgery

82
Q

Which nerve is most likely to be injured during an AC IV insertion?

A

median

83
Q

Etiologies of median nerve injury include:

A

Elbow hyperextension
carpal tunnel syndrome
AC IV

84
Q

The median nerve runs next to which veins?

A

Basilic and median cubital

85
Q

What is the presentation of a median nerve injury?

A

Palmar surface of thumb

Inability to oppose thumb

Hand of benediction
(inability to clench fist)

86
Q

Which nerve passes through the spiral groove?

A

Radial

87
Q

Radial nerve can be injured by:

A

external compression by an IV pole

excessive BP cycling

UE tourniquet

tucking too tight

88
Q

Which nerve innervates serratus anterior?

A

SALT:

Serratus anterior long thoracic

89
Q

Damage to the long thoracic manifests as:

A

scapular winging

90
Q

Damage to the suprascapular nerve manifests as:

A

dull shoulder pain

91
Q

Damage to the suprascapular nerve is usually caused by:

A

ventral circumduction (rolling onto the dependent arm in lateral position)

92
Q

Obturator injury manifests as:

A

inability to ADDUCT the leg

93
Q

Obturator injury is usually caused by:

A

flexion of thigh toward groin

Excessive traction during abdominal surgery

forceps delivery

94
Q

Femoral nerve injury manifests as:

A

impaired knee and hip extension

Lost sensation over anteromedial surface of leg

95
Q

Femoral nerve injury is usually caused by:

A

excessive traction during abdominal surgery

96
Q

Saphenous nerve injury manifests as:

A

reduced sensation of anteromedial leg

97
Q

Saphenous nerve injury is usually caused by:

A

external pressure to medial leg

98
Q

common peroneal injury manifest as:

A

foot drop and inability to evert

99
Q

common peroneal injury is usually caused by:

A

external pressure at fibular head (lithotomy)

Fibula = Peroneal
Tibial = Saphenous

100
Q

Sciatic nerve injury is usually caused by:

A

excessive flexion and abduction in lithotomy

101
Q

sciatic nerve injury manifests as:

A

foot drop

102
Q

Pudendal nerve injury is usually caused by:

A

compression against a perineal post on a fracture table

103
Q

pudendal nerve injury presents as:

A

loss of penile sensation

104
Q

Leaving the legs crossed leads to injury in which nerves?

A

sural (top leg)
superficial peroneal (bottom leg)

105
Q

sitting with legs straight can injure which nerve?

A

Sciatic

106
Q

compartment syndrome is most common in which position?

A

lithotomy

107
Q

what causes midcervical tetraplegia?

A

hyperflexion of the neck

AND tracheal resection

108
Q

What is the BEST positioning device in prone?

A

Jackson table is better than wilson or chest rolls

109
Q

When intubating someone with an anterior mediastinal mass you should do two things:

A

maintain spontaneous ventilation

use a reinforced ETT

110
Q

which body part should be placed over the kidney rest?

A

iliac crest

111
Q

The saphenous is injured:

A

when the MEDIAL leg is contacted

112
Q

The common peroneal is injured when:

A

the LATERAL leg is contacted

Apex (46 decks)

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