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ANESTHESIA : Hall > CH6 GENERAL ANESTHESIA > Flashcards

CH6 GENERAL ANESTHESIA Flashcards

1
Q

longest acting sulfonylurea

A

CHLORPROPAMIDE

DURATION 72 hrs

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2
Q

duration of regular insulin

A

peak 2-3 hrs

duration 6-8 hrs

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3
Q

a QUALITATIVE assesment of pseudocholinesterase

A

DIBUCAINE TEST

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4
Q

amide type LA

inhibit normal pseudocholinesterase by 80%

A

DIBUCAINE

amide ( 2 i)
ester (1i)

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5
Q

Normal PO2 in mixed venous blood is?

A

40mmHg

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6
Q

inc Venous arterial oxygen due to ?

A 
inc CO
sepsis
left to right shunt
impaired peripheral uptake
dec o2 consumption
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7
Q

Tracheal capillary arteriolar pressure

A

25-35mmHg

if cuffed greater > ischemia> tracheomalacia

ET low pressure cuff recommended for intubation> 48 hrs

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8
Q

LMWH like enoxaparin dalterapin and ardeparin should be stop for __hrs prior to neuraxial.

A

at least 24 hrs

LMWH is 2-4 x longer than standard heparin

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9
Q

The most common peripheral nerve injury under GA?

A

ULNAR NERVE

compressed between medial epicondyle of the humerus

sharp edge of the operating table

leading to ISCHEMIA

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10
Q

CODEINE is metabolized to morphine by

A

CYP2D6

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11
Q

CYP2D6 metabolize (3 drugs)

A

oxycodone to oxymorphone
hydrocodone to hydromorphone
codeine to mso4

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12
Q

s/p pca or pci when to schedule elective case

A

2 week - baloon ca
6 weeks - BMS( bare metal)
12 mons - DES( Drug eluting)

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13
Q

DUAL THERAPY
ASPIRIN AND CLOPIDOGREL

when to stop?

A

continue aspirin

clopidogrel 7 days

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14
Q

emergency case on clopidogrel ? what to give?

A

platelet conc effective 4hrs after last dose but much better 24 hrs after

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15
Q

NALOXONE

A

competitive inhibitor all opioid receptors
greater affinity to mu receptor

duration :1hr
short can cause renarcotization

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16
Q

NALTREXONE

A

N cyclopropylmethyl of oxymorphone

long half life 8-12 hrs
oral form only

block euphoric effect

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17
Q

NALMEFEME

A

opiod antagonist
extremely long duration of action

oral and iv

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18
Q

most common cause postoperative hypoxemia

A

uneven v/q mismatch

atelectasis

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19
Q

AIRWAY obstruction after thyroidectomy cause by

A 
hypocalcemia
RLN damage
tracheomalacia 
compression
hematoma
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20
Q

airway symptoms of hypocalcemia can develop

A

as early as 1-3 hrs up to 24-72 hrs post op

laryngeal muscle is sensitive to hypocalcemia

tx
cal gluconate
ca chloride

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21
Q 
weakness in abduction of the thumb
inability to extend to metacarpophhalangeal joints
wristbdrop
numbness in the webbed space 
between thumb and index

what nerve?

A

RADIAL NERVE

can be comprrss around the humerus b/w middle and lower portions spiral groove

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22
Q

dystonic reaction about 1%

A

DROPERIDOL

TX
DIPHENHYDRAMUNE
BENZATROPINE ( can cross bbb)

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23
Q

most freq injured nerve in the antecubital fossa

A

MEDIAN NERVE

palmar surface of the lat 3 and 1 half fingers

motor:
abductor pollicis brevis
flexor pollicis brevis
opponens pollicis ms

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24
Q

diaphoresis
tachycardia
heache
htn

A

pheochromocytoma

average sized contains 100-800mg NE

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25
Q

pheochromocytoma +
medullary ca thyroid +
and neuroma of the oral mucosa

A

MEN Type IIb

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26
Q

dec hepatic gluconeogenesis

not hypoglycemia

A

METFORMIN

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27
Q

improve insulin sensitivity

no hypoglycemia effect

A

piolitazone

rosiglitazone

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28
Q

delay carbo absorption

no hypo gly

A

Acarbose

miglitol

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29
Q

stimulate insulin secretion

RISK of hypogly

A 
glimeperide
glipizide
glyburide
tolbutanidr
tolazamide
chlor
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30
Q

alcohol withdrawal
early symptoms?

life threatening ?

A

alcohol withdrawal
early symptoms? 6-8hrs

life threatening ?2-4days

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31
Q

HYPERCALCEMIA SIGNS AND SYMPTOMS

A 
HTN
dysrhythmia
short qt 
kidney stoney
seizure 
nause and vomiting
weakness a
depression 
psychosis

<12 no intervention

notmal 2.25-2.75mmol/l

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32
Q

red eyedrop?
green eyedrop?
white?

A

reD-myDriasis
green -MIOSis

white no pupillary size changes

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33
Q

wt in children how to compute?

A 
newborn-3.5kg 
5mons bw x 2
1year bw x 3 
1-6 2kg/year
6-10 3kg/year
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34
Q

HYPERCALCEMIA SIGNS AND SYMPTOMS

A 
HTN
dysehythmia
short qt 
kidney stoney
seizure 
nause and vomiting
weakness a
depression 
psychosis

<12 no intervention

notmal 2.25-2.75mmol/l

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35
Q

red eyedrop?
green eyedrop?
white?

A

reD-myDriasis
green -MIOSis

white no pupillary size changes

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36
Q

wt in children how to compute?

A 
newborn-3.5kg 
5mons bw x 2
1year bw x 3 
1-6 2kg/year
6-10 3kg/year
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37
Q

WHAT CBF ?

first sign of cerebral ischemia
no eeg sign

A

22ml/100g/min

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38
Q

What CBF?

eeg become isoelectric

A

15ml/100g/min

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39
Q

what CBF?

irreversible membrane damage an cellular death

A

6ml/100g/min

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40
Q

what CBF?

zone of ischemic penumbra

A

6-15ml/100g/min

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41
Q

PEEP increase?

A

arterial oxygenation
pulmonary compliance
FRC

by expanding prev collapsed but perfused alveoli&raquo_space; dec shunt&raquo_space; imp ventilatio

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42
Q

PEEP effect ok arterial blood pressure?

A

dec arterial blood pressure caused by dec in venous return , left ventricular filling and stroke volume and cardiac output

other adverse effect:
pneumothorax
pneumomediastinum
subq emphysema

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43
Q

clopidogrel MOA?

A

irrevesible inhibitor of plt p2Y12

block ADP
Inhibit platelet activation, aggregation
and degranulation

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44
Q

Glycoprotein 2b/3a inhibitor?

A

abcixima
eptifabatidr
tirofiban

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45
Q

inhibit cox1 ?

inhibit release of ADP by platelet and plt aggregation

A

aspirin
naproxen
ibuprofen

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46
Q

Direct thrombin inhibitor?

A 
hirudin
agratroban
lepirudin 
desidurin
bivalirudin 
DABIGATRAN

supress plt function

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47
Q

how to compute for oil/gas

coefficient

A

150/MAC

high - lipid soluble ( lower MAC)

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48
Q

HYPERNATREMIA
serum hyperosmolarity
polyuria
urine hypoosmolality

A

DIABETES INSIPIDUS

develop 4-12 hrs post op

txt desmopressin acetate
DDAVP

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49
Q

in alzheimer disease,
which anticholinergic drug should not be given

scopolamine
atropine
glycopyrolate

A

scopolamine and atropine

can pass the bbb
can cause confusion

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50
Q

administration of sux to any pt who has already received an anticholinesterase will result ina PROLONGED block ?

true or false

A

TRUE

because it can no longer be easily hydrolyzed

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51
Q

measurement of DIFFUSING capacity of the lung

A

DLCO

20-30ml/min/mmHg

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52
Q

DLCO influenced by ?

A

vol of blood hgb

dec DLCO:
dec oxygen toxicity
pulmonary edema

increased DLCO:
supine position
exercise
obesity
left to right cardiac shunt
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53
Q

Thyroidectomy

postoperative complication results in upper airway obstruction?

A

hemorrhage - compression
hypocalcemia- stridor – laryngospasm

recurrent laryngeal nerve
unilateral- hoarseness
bilateral - airway obstruction

sup laryngeal nerve sensory only
hoarseness only

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54
Q

MH

most early signs ?

A

TACHYCARDIA

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55
Q

nonspecific pulmonary function test that measures the ENDURANCE of ventilatory muscles and indirectly reflects compliance of the lung and thorax as airway resistance

A

MMB
MAXIMUM VOLUNTARY VENTILATION

dec- impairment to inspiration or rxpiration

FLOW VOLUME LOOP- confirmatory test

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56
Q

PADSS

what are the five criteria

A 
stable vs
walk w/o dizziness
controlled pain
absence of nausea and vomiting
min sx bleeding
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57
Q

TOOL TO OBJECTIVELY assesing a patients readiness for discharge from the surgical center and includes 5 criteria

A

PADSS
post anethetics discharge
scoring system

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58
Q

MH

LATE finding

A

fever

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59
Q

test for MH

A

caffeine halothane contracture test

muscle biopsy

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60
Q

leukotriene pathway inhibitor

A

zileuton

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61
Q

leukotriene receptor antagonist

A

montelukast

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62
Q

Treatment of mild hyponatremia 120-135

A

water restriction
furosemide

no neuro symptoms

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63
Q

what level of na has neurologic symptoms

ecg changes

A

less than 120

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64
Q

hyponatremia ecg changes?

A

widening qrs
st elevation
ventricular tach
vfib

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65
Q

how to compute for na correction

A

TBW x ( desirrd- actual na )

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66
Q

rapid correction of na will lead to

A

demyelinating cns

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67
Q

MH
TRISMUS after sux

in how many % inpatient will develop MH

A

50 percent

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68
Q

KETAMINE demonstrate myocardial depressant when??

A

cathecholamines are depleted

under deep anesthesia

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69
Q

MH is due to ____ control of intracelluar _____

A

MH is due to DEC control of intracelluar CALCIUM STORE

tx dantrolene
blocks the release of calcium from sarcoplasmic reticulum

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70
Q

inc intracellular ca leads to muscle contraction ?

true or false

A

true

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71
Q

bleomycin

A

PULMONARY TOXICITY

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72
Q

increase risk of pulmonary toxicity ( in pt taking bleomycin)

A

radiotherapy

inc conc of 02 ( > 30percent)

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73
Q

head flexion or extension, how many cm?

A

1.9 cm towards the carina

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74
Q

turn head laterally will move the et tube ___cm?

A

0.7cm away from the carina

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75
Q

sulfur hexafluoride ppv

to prevent changes in size of the bubbles?
can nitrous be given?

A

prevention: 02. 15mins before injevtion

NO NITROUS FOR 10days

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76
Q

post thyroidectomy , hypocalcemia can occur ___hrs?

A

first 24 -96 hrs

manifest as laryngospasm and stridor

tx: cal gluconate and ca chloride

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77
Q

which confirms euthyroid state?

A

TSH

78
Q

TURP:

fluid absorption rate ?

A

10-30ml/min

79
Q

TURP:

inc rate of absorption can cause?

A

htn
bradycardia
pulmonary congestion

treatment:
diuretics
3% nacl

80
Q

BURN:
after 24 hrs
sensitivity to depo? or non depo?

A

depo sensitive
non depo resistant

upregulation of extrajunctional recptor

81
Q

nerve injured during parotidectomy

A

FACIAL NERVE
orbicularis oris
frontalis

close ehwlids
purse the kips
raise the eyebrows

82
Q

how manu ml of 02 is ther per gram of hgb?

A

1gram hgb=1.34ml O2

83
Q

allergic reaction is most likely secondary to

A

MUSCLE RELAXANT

latex allergy after 15-mins

84
Q

HUNTINGTON CHOREA

effects on succinylcholine

A

PROLONGED

INC SENSITIVITY TO NON DEPO

because they have dec pseudocholinesterase

85
Q

normal intraocular pressure

A

10-22mmHg

86
Q

causes inc in iop

A

ketamine
elevation of PaCO2
sux
coughing and vomiting ( 35-50mmHg)

87
Q

AHI

apnea-hypopnea index ?

A

used to QUANTIFY number of apnea or hypoapnea per hr

greater than 30&raquo_space;> OSA

88
Q

no ventilation for period of 10sec or more

A

APNEA

89
Q

50% dec in airflow or a dec sufficient to cause dec oxygen saturation of 4%

A

HYPOPNEA

90
Q

INCREASED operative risk for pneumonectomy?

what are the test?

A 
RV/TLC >50 
FEV1 < 0.8L
mPAP >40mmHg
PaCO2 60mmhg
PaO2 <45 mmHg
91
Q

for every degree Celsius decreased how many percent dec with PaO2

A

1 degre = 6 %

92
Q

nonspecific pulmonary function test that measures the ENDURANCE of ventilatory muscles and indirectly reflects compliance of the lung and thorax as airway resistance

A

MMB
MAXIMUM VOLUNTARY VENTILATION

dec- impairment to inspiration or rxpiration

FLOW VOLUME LOOP- confirmatory test

93
Q

PADSS

what are the five criteria

A 
stable vs
walk w/o dizziness
controlled pain
absence of nausea and vomiting
min sx bleeding
94
Q

TOOL TO OBJECTIVELY assesing a patients readiness for discharge from the surgical center and includes 5 criteria

A

PADSS
post anethetics discharge
scoring system

95
Q

MH

LATE finding

A

fever

96
Q

test for MH

A

caffeine halothane contracture test

muscle biopsy

97
Q

leukotriene pathway inhibitor

A

zileuton

98
Q

leukotriene receptor antagonist

A

montelukast

99
Q

Treatment of mild hyponatremia 120-135

A

water restriction
furosemide

no neuro symptoms

100
Q

what level of na has neurologic symptoms

ecg changes

A

less than 120

101
Q

hyponatremia ecg changes?

A

widening qrs
st elevation
ventricular tach
vfib

102
Q

how to compute for na correction

A

TBW x ( desirrd- actual na )

103
Q

rapid correction of na will lead to

A

demyelinating cns

104
Q

MH
TRISMUS after sux

in how many % inpatient will develop MH

A

50 percent

105
Q

KETAMINE demonstrate myocardial depressant when??

A

cathecholamines are depleted

under deep anesthesia

106
Q

MH is due to ____ control of intracelluar _____

A

MH is due to DEC control of intracelluar CALCIUM STORE

tx dantrolene
blocks the release of calcium from sarcoplasmic reticulum

107
Q

inc intracellular ca leads to muscle contraction ?

true or false

A

true

108
Q

bleomycin

A

PULMONARY TOXICITY

109
Q

increase risk of pulmonary toxicity ( in pt taking bleomycin)

A

radiotherapy

inc conc of 02 ( > 30percent)

110
Q

head flexion or extension, how many cm?

A

1.9 cm towards the carina

111
Q

turn head laterally will move the et tube ___cm?

A

0.7cm away from the carina

112
Q

sulfur hexafluoride ppv

to prevent changes in size of the bubbles?
can nitrous be given?

A

prevention: 02. 15mins before injevtion

NO NITROUS FOR 10days

113
Q

post thyroidectomy , hypocalcemia can occur ___hrs?

A

first 24 -96 hrs

manifest as laryngospasm and stridor

tx: cal gluconate and ca chloride

114
Q

which confirms euthyroid state?

A

TSH

115
Q

TURP:

fluid absorption rate ?

A

10-30ml/min

116
Q

TURP:

inc rate of absorption can cause?

A

htn
bradycardia
pulmonary congestion

treatment:
diuretics
3% nacl

117
Q

BURN:
after 24 hrs
sensitivity to depo? or non depo?

A

depo sensitive
non depo resistant

upregulation of extrajunctional recptor

118
Q

nerve injured during parotidectomy

A

FACIAL NERVE
orbicularis oris
frontalis

close ehwlids
purse the kips
raise the eyebrows

119
Q

how manu ml of 02 is ther per gram of hgb?

A

1gram hgb=1.34ml O2

120
Q

allergic reaction is most likely secondary to

A

MUSCLE RELAXANT

latex allergy after 15-mins

121
Q

HUNTINGTON CHOREA

effects on succinylcholine

A

PROLONGED

INC SENSITIVITY TO NON DEPO

because they have dec pseudocholinesterase

122
Q

normal intraocular pressure

A

10-22mmHg

123
Q

causes inc in iop

A

ketamine
elevation of PaCO2
sux
coughing and vomiting ( 35-50mmHg)

124
Q

AHI

apnea-hypopnea index ?

A

used to QUANTIFY nuper of apnea or hypoapnea per hr

greater than 30&raquo_space;> OSA

125
Q

no ventilation for period of 10sec or more

A

APNEA

126
Q

50% dec in airflow or a dec sufficient to cause dec oxygen saturation of 4%

A

HYPOPNEA

127
Q

INCREASED operative risk for pneumonectomy?

what are the test?

A 
RV/TLC >50 
FEV1 < 0.8L
mPAP >40mmHg
PaCO2 60mmhg
PaO2 <45 mmHg
128
Q

for every degree Celsius decreased how many percent dec with PaO2

A

1 degre = 6 %

129
Q

causes of central cyanosis

A

dec arterial o2 saturation

hgb abnormality

130
Q 
what kind of heparin?
immediate 
t1/2 .5 to 2hrs
reversed by protamine
aptt
act
A

UNFRACTIONATED HEPARIN

131
Q 
what kind of heparin? 
20-60 mins onset
t1/2 4.5hr 
partially reverse by protamine 
LOWER INCIDENCE OF HIT
A

LMWH

132
Q

relationship of gfr and crea ?

A

inversely proportional

133
Q 
MC chromosomal syndrome 
in congetinal hypothyroidism 
smaller tracheas 
occipito atlantaoaxial isntability
subluxation
congetinal heart disease
A

TRISOMY 21

Downs syndrome

134
Q

anticholinergic like scopolamine can cause

A

mydriasis

cyclopedia

135
Q

neuroleptic malignant syndrome vs MH DIFFERENTIATE?

A

Non depo NMB will cause FLACCID paralysis in NMS but not in MH

136
Q

classic signs of fat embolism

A 
tachycardia 
dyspnea 
confusion
fever
PETecHial rash on the upper part was

most common after LONG BONE sx

occurs 12-72 hrs after

137
Q

REMIFENTANIL IS metabolized by

A

nonspecific pseudocholinesterasr

138
Q

acceptable preductal oxygen saturation

A 
1 min - 60-65 
2 min 65
3min 70 
4min 75 
5 mins 80 
10 min 85 a%
139
Q

MOST common readin for unexpected admission post GA

A

nausea and vomiting

140
Q

min alveolar concentration of anesthetic that will prevent movement of 50% of pt whwn skin incision is made

A

MAC 1

141
Q

min alveolar concentration of anesthetic that will prevent movement of 95% of pt whwn skin incision is made

A

MAC 1.3

142
Q

OBESE:

cardiac output increased or decreased?

A

increased by
100ml/min/kg

additional blood vessel> inc ventricular dilation inc sv and

resting hr not increased

143
Q

alternative for Na nitroprusside for tx for severe htn?

A

FENOLDOPAM
Dopamine 1 agonist

no thiocyanate toxicity
no rebound effect
no coronary stral

contraindicated:
sulfite sensitivity

144
Q

Hemophilia

how many percent of F8 is needed for major or

A

ideally 100 percent

F8 elimination t1/2 12 hrs

tx
F8 conc
cryoprecipitate

145
Q

THE REASON 4 twitches are used in TOF instead of 5?

A

succesive twitches deplete ach syore

after 4th twitch ni affitional decrement in height

146
Q

INFERIOR ISCHEMIA
complete heart block

what coronary artery

A

right RCA

AV NODE supplied by the RCA

147
Q

INCREASE MAC

A 
hyperthermia
CHRONIC ETHANOL USE
hypernatremia
red hair natural
infancy
148
Q

DECREASE MAC

A 
narcotics
iv
LA
ACUTE ETHANOL USE
hypothermia
Hypoxia
anemia
inc age 
pregnancy 
hypoxia
149
Q

NO EFFECT IN MAC

A 
duration sc
typr sx
thyroid function 
gender
hyperkalemia
150
Q

long term lithium therapy can cause

A

hypothyroidism ( inhibit thyroid hormones)
sedative properties
associated nephrogenic DI
prolong osncu and sux but does not cause hyperkalemia

151
Q

Carcinoid syndrome

tx

A

octreotide

synthetic somatostatin analog surpress serotonin

152
Q

minimum dermatomal level for orchiectomy

A

T10

153
Q

GCS ?
mild head injury
moderate and severe?

A

severe 3-8
mod 9-12
mild 13-15

e4 v5 m6

154
Q

associated with FALSELY elevated SaO2 ?

A

CARBOCYHEMOGLOBIN

155
Q

anticonvulsant

centrally acting active GABA

A

GABAPENTIN

156
Q

most common cause of blindness post surgery?

A

ISCHIEMIA OPTIC NEUROPATHY

associated factors:
prolonged hypotension
anemia
large blood loss
prolonhed surgery 
favial edema
157
Q

POVL may result form

A 
corneal traume
retinal artery occlusion 
retinal vein occlusion
optic nerve ischemia 
cortical disease
158
Q

postoperative shivering. can ..

A

inc metabolic rate and o2 consumption

inc co and mv

159
Q

postoperative shivering treatment

A 
suppl o2 
rewarming
meperidine 
clonidine
mg sulfate ca chloride
chlorpromazine 
droperidol
drugs:
meperidine
clonidine 
mg 
cacl
chlorpromazine 
butorphanol
160
Q

hyperkalemia ecg changes?

A

narrowed and peaked t wave ( earliest manifestation)

dec p wavr
prolonged pr interval
widened qrs

potentianed by hypocalcemia

161
Q

s/p tss is Cpap contraindicated?

A

YES !

162
Q

neutral protease stored in mast cell ?

A

TRYPTASE

should be measure 1-2 hrs

histamine level returns to normal after 30-60 mins

163
Q

what enzyme is responsible to metablosim of fentanyl
sulfentanil
alfentanul

A

CYP3A4

164
Q

LIVER TRANSPLANTATION

phase where the greatest degree of hemodynamics

A

REPERFUSION

Hypotension
dec cardiac contractilitcardiac arrythmia
hyperkalemia

165
Q

PONV:

Strongest independent predictor

A

FEMALE

166
Q

PONV:

risk factor

A 
female
non smoker
hx of ponv migraine
narcotics
length of sx use of nitrous 
voltile anes
167
Q

MH MUTAtion with what receptor

A

RYANODINE RECEPTOR

168
Q

glycopyrrolate can pass the placenta? true or false?

A

FALSE

only ATROPINE AND SCOPOLAMINE

169
Q

greatest predictor of OSA

A

neck circumference

>44cm

170
Q

conversion of morphine iv to oral?

A

1:3

methadone
1:2

me2done

171
Q

equilibrium with alveolar partial pressure is rapid , how many mins?

A

8-10mins

172
Q

which compartment reach equilibrium last?

A

VPG

vessel poor group

173
Q

hazards of oxygen administration

A

ROP
bronchopulmonary dysasia
adsorption atelectasis

174
Q

what nerve arises from branches of c2-c3 spinal nerves and innervates the skin of the outer ear, the mastoid process and the parotid gland

A

GREAT AURICULAR NERVE

175
Q

vasopasm

A

associated with SAH

OCCURS 4-12 days after bleed

176
Q

treatment for hodgkin lumphoma and testicular tumor .

causing pulmonary toxicity

A

BLEOMYCIN

use low oxygen concentration

177
Q

most common cardiac event in pediatrics

A

bradycardia

178
Q

difficult mask ventilation

A 
bmi >26 
without teeth
pt who snore
beard 
age older than 55
facial tumor
facial trauma
179
Q

symptoms of compartment syndrome

A

pain
parethesias
paralysis
pulseless

treatment? fasciotomy

180
Q

CSF IN NEONATES?

LA dose?
duration

A

4ml/kg

adult: 2ml/kg

increase dose
shorter duration

181
Q

ET TUBE SIZE are measured according to

A

INTERNAL DIAMETER

182
Q

colorless, odorless gas that bonds to hgb with affinity more than 200 times stronger than oxygen.

A

carbon monoxide

183
Q

what nerve ?

weakness of all muscles below the knee

A

SCIATIC NERVE INJURY

184
Q

what nerve ?

foot drop, loss of dorsal extension of the toes

A

common peroneal nerve

185
Q

what nerve ?

weakness of the ms that exten the knee

A

obturator nerve injury

186
Q

what nerve ?

inability to addduct the leg; diminished sensation over the medial side of the thigh

A

OBTURATOR NERVE INJURY

187
Q

what nerve ?

mc caused by placement of pt into lithotomy position

A

common peroneal

188
Q

what nerve ?

numbness over the lateral aspect of the thigh

A

lateral femoral cutaneous nerve injury

189
Q

amount of air expired in 1 second

A

FEV1

190
Q

normal FEV/FVC

A

75%- 80%

ANESTHESIA : Hall (6 decks)

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