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COMP EXAM 16 > Comp 16 > Flashcards

Comp 16 Flashcards

1
Q

What is the density of CSF?

A

1.003

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2
Q

How much buffer is available in sodium bicarb 8.4%?

A

50 mEq

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3
Q

What is the best plan for emergence and post op air management for adult who has undergone total laryngectomy?

A

SV with trach collar, uncuffed laryngectomy tube

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4
Q 
FiO2 = 0.21
SaHbo2 = 86%
SaHbCO = 0.4%
SaMET= 0.2%
PaO2 = 72 mmHg
PaCO2= 38 mmHg
pH = 7.36
Hb= 17.6

What is the acid-base state?
What is the acid-base condition?

A

Normal

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5
Q

What is the initial dose of intralipid for LA toxicity?

A

1 mg/kg over 1 min

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6
Q

What is the YAG laser advantage over CO2 laser for airway surgery?

A

Atttracts dark pigment (Hbg) that helps with controlling the bleeding

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7
Q

What total score for fast-track criteria bypasses the recovery room?

A

12 or greater

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8
Q

What score obviates (removes) fast tracking?

A

0 in any category

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9
Q

What are the guidelines for neuraxial anesthesia in patients taking daily aspirin 82mg?

A

continue

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10
Q

What regional anesthetic technique will most likely produce ipsilateral diaphragmatic paresis or paralysis?

A

interscalene block

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11
Q

What narcotics are prohibited for administration in PACU to outpatients?

A

none

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12
Q

What V/Q type of lung unit produces hypoxemia associated with post-op atelectasis?

A

low V/Q

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13
Q

Which way will the following reaction be driven as blood becomes more acidemic?

R-NH3+ R-HN2 + H+

A

to the left

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14
Q

What diagnosis should be made for suppurative inflammation of subcutaneous connective tissue in the submental space? Name 2 associated comorbid conditions.

A

Ludwig’s Angina

Diabetes mellitus
Dental abscess

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15
Q

What is rhabdomyolysis?

A

The breakdown of muscle tissue that results in muscle fiber contents being released in the bloodstream

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16
Q

What perioperative risks does rhabdomyolysis pose?

A

acute renal failure because the muscle fiber content is hard on the kidneys

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17
Q

What is the approximate pH of sodium bicarb?

A

7.8

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18
Q

For the pt who has suffered significant hemorrhage due to blunt trauma, the best method of restoring blood pressure will be with the administration of?

A

blood

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19
Q

Indocyanine green would be injected after a TAH because:

A

want to determine patency of ureters to ensure they ligate the ureters

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20
Q

When acidemia occurs, what is the human body’s fundamental response direced towards?

A

buffering –> respiratory –> renal

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21
Q

A diabetic pt who has not taken insulin for 3 days presents with abdominal pain, vomiting, lethargy, RR 32, PR 134, BP 149.96, T = 38.8. What is the most likely acid base disorder?

A

Metabolic acidosis

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22
Q

In the first 3 postop days following massive fluid resuscitation with LR what will most likely occur in a pt who has a good surgical oucome?

A

metabolic alkalosis b/c lactate –> bicarb in liver

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23
Q

What physiologic effect describes deoxygenated Hb having a greater affinity for hydrogen ions than oxygenated Hb?

A

Bohr

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24
Q

What drug can be injected via IV prior to administration of etomidate to prevent tonic-clonic activity?

A

magnesium

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25
Q

What occurs with bilateral RLN paralysis? (2)

A

stridor

aphonia

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26
Q

What occurs with unilateral RLN paralysis?

A

hoarseness

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27
Q

What is the appropriate treatment for a tension pneumothorax?

A

large bore needle into 2nd intercostal space in midclavicular line

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28
Q

What are the signs of cardiac tamponade? (5)

A 
tachycardia, low bp
dyspnea
chest pain
pulsus paradoxus
increased CVP
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29
Q

What is “Beck’s Triad”?

A

Signs to directly assess cardiac tamponade:

distended neck veins (look)
hypotension (feel)
muffled heart sounds (hear)

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30
Q

What is the best method to restore BP in a trauma pt who suffered significant hemorrhage?

A

Type O, Rh negative blood

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31
Q

How do you manage the airway in a pt with a laryngectomy?

A

anode tube, 2nd black line can be placed at the level of the marker

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32
Q

Is the larynx essential for speech?

A

no

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33
Q

How would the anesthetic plan for pt with rhabdomyolysis be modified?

A

avoid renally metabolized drugs

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34
Q

Which of the following is modified RSI appropriate?

closed head injury
planned surgery
rhabdomyolysis
tachypnea
unknown gastric contents
A

unknown gastric contents

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35
Q

How do you manage an open globe injury in a pt with pseudocholinesterase deficiency?

A

no sux

Roc at 1.2 mg/kg

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36
Q

What is an appropriate rate of infusion for epi?

A

0.05 mcg/kg/min

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37
Q

If blood is not initially available for a trauma patient with major hemorrhage, what drugs should be administered along with IV fluids to resuscitate the patient?

A

epi

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38
Q

What test is used to determine fibrinolysis?

A

d-dimer which is a fibrin degradation product which is a small protein that is present in the blood after a blood clot is degraded by fibrinolysis. It contains 2 cross linked D fragments

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39
Q

Why are D-dimers ordered?

A

To rule out the presence of a thrombus such as DVT, PE, and strokes

Test is necessary to diagnose conditions that cause hypercoagulability and DIC for example

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40
Q

What is a normal, or negative, D-dimer?

A

< 500 mg/ml

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41
Q

What does a positive D-dimer indicate?

A

thrombus

DIC (very elevated D-dimer)

42
Q

If bound calcium is low, what do we expect ionized calcium to be?

What are normal ionized levels of Ca?

A

Ionized calcium can be normal even if the bound calcium is low.

Ionized Ca = 1.2 - 1.3 mg/dL

43
Q

What is leukocytosis and when does it occur most often?

A

elevated WBC count

most commonly a result of infection –certain parasitic infections

44
Q

What is a normal WBC level?

A

4.5 - 11 mm^3

45
Q

What are normal bicarbonate levels?

A

22 - 26

46
Q

How is metabolic alkalosis determined?

A

bicarb > 26

47
Q

How is metabolic acidosis determined?

A

bicarb < 22

48
Q

At what creatinine level is GFR decreased by half?

A

2 * normal creatinine levels

49
Q

What are normal Na levels?

A

135 - 145

50
Q

What are normal K levels?

A

3.5 - 4.5

51
Q

What are normal Cl levels?

A

95 - 105

52
Q

What are normal CO2 levels?

A

22 - 29

53
Q

What are normal BUN levels?

A

7 - 21

54
Q

What are normal creatinine levels?

A

0.5 - 1.5

55
Q

What are normal Hb levels?

A

12 - 17

56
Q

What are normal Hct levels?

A

Hb * 3

57
Q

What are normal Plt levels?

A

150 - 400 k

58
Q

What is GGTP?

A

glutanyl transpeptidase

It is a test to detect biliary obstrucion, cholangitis, cholecystitis

59
Q

What does increased ammonia indicate?

A

end stage liver disease

60
Q

What does decreased albumin indicate?

A

liver damage

61
Q

What does an increased conjugated bilirubin indicate?

A

bile duct blockage

62
Q

What factor deficiency leads to a prolonged PT and a normal PTT?

A

factor 7

63
Q

What lab will be prolonged with intrinsic factor issues, von Willebrands dz and hemophilia A and B?

A

PTT

64
Q

What ACT is acceptable for CPB?

A

> 400

65
Q

What is therapeutic INR for warfarin pts?

A

2.0 - 3.0

66
Q

What is the equation for calculating pH?

A
  • log [H+]
67
Q

What does paCO2>45 indicate?

A

respiratory acidosis

68
Q

How can you calculate HCO3?

A

using Henderson Hasselbach equation

pH = pKa + log [HCO3/CO2]

69
Q

Increased amylase values indicate what?

A

acute pancreatitis which will be 4 - 5 times greater

70
Q

What does increased lipase values indicate?

A

acute pancreatitis which will be 5-6 times greater

71
Q

What does decreased lipase indicate?

A

permanent damage to pancreatic cells

72
Q

What is an example of a disease results in low lipase levels?

A

cystic fibrosis

73
Q

How much buffer is available in sodium bicarb 8.4%?

A

50 meq/ 50 cc –> 1 meq/ml

74
Q

What is the anion gap equation?

A

Na + K - Cl - HCO3

75
Q

What is the normal range for anion gap?

A

7 - 14 mEq/L

76
Q

What does an anion gap > 30 indicate?

A

high anion gap acidosis

77
Q

How do the kidneys influence metabolic and respiratory disturbances?

A

control the amount of bicarb resorbed
form new bicarb
eliminate H+

78
Q

Describe the Bohr effect.

A

deoxygenated Hb has a greater affinity for H+ than does oxyHb

79
Q

Describe the Haldane effect.

A

deoxygenated Hb has a greater affinity for CO2 than does oxyHb

80
Q

When acidemia occurs, what is the body’s fundamental response directed towards?

A

maintaining the pH

81
Q

What are the chronological changes that occur in response to acidemia?

A

buffering –> ventilation –> renal changes

82
Q

A diabetic patient who has not taken insulin for 3 days presents with abdominal pain, vomiting, lethargy, RR = 32/min, 148/96 and temp 38.8. What is the most likely acid-base disorder?

A

metabolic acidosis…which occurs in insulin deficiency

83
Q

What patients are most suitable for fast track recovery, bypassing phase I? (2)

A

MAC sedation

extremity regional anesthesia

84
Q

What does the Aldrete score observe? (5)

A 
Activity
Respiration
Circulation
Consciousness
Oxygenation
85
Q

What are SAFE drugs in the outpatient setting?

A

Short acting

Fast emerging

86
Q

During a GA, how should the eyes be protected for a pt who has recently undergone LASIK surgery?

A

tape them closed

87
Q

What is the selection criteria for outpatient anesthesia?

A

ASA I or II of varying age

Arbitrary limits on age, duration of the procedure, use of premeds other than narcotics

88
Q

What are ASA practice guidelines for children to take breast milk preop?

A

> 4 hours

89
Q

What are the guidelines for NPO for light meals?

A

> 6 hours

90
Q

What are the levels of differential blockade?

A

Sympathetic blockade is 2 segments higher than sensory which is 2 segment higher than motor blockade

91
Q

If warfarin initial dose was given > 24 hours, how should you proceed with neuraxial?

A

check PT/INR

92
Q

If warfarin initial dose was given < 24 hours and only 1 dose was given, how should you proceed with neuraxial?

A

safe to proceed

93
Q

If pt is taking ASA and/or NSAIDS, how should you proceed with neuraxial?

A

safe to proceed

94
Q

If pt is taking minidose subq heparin, how should you proceed with neuraxial?

A

safe to proceed, blocks should be performed 1 hour or more before heparin administration

95
Q

What test checks for heparin levels?

A

PTT/ACT

96
Q

If pt is taking LMWH, how should you proceed with neuraxial?

A

Wait to place needle at least 10 hours after last dose

97
Q

If pt is taking fibrinolytics how should you proceed with neuraxial?

A

NOT safe to proceed

98
Q

What nerves are blocked in an ankle block?

A 
DP
PT
Sural 
Saphenous
Superficial peroneal
99
Q

What nerve blocks the great toe?

A

DP

100
Q

What drugs can reverse a spasm of the sphincter of oddi?

A

Narcan
Nitroglycerine
Atropine
Glucagon

101
Q

Name the phases of capnogram.

A

Phase 0: inspiration
Phase 1: deadspace
Phase 2: deadspace and alveolar gas
Phase 3: alveolar gas

102
Q

What is the main cause of hypoxemia after repositioning?

A

Mainstem intubation

COMP EXAM 16 (2 decks)

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