Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anesthesiologist Assistant > Comp Exam III > Flashcards

Comp Exam III Flashcards

1
Q

Drug and dose to treat post-op shivering

A

Meperidine (Demerol)
25mg IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Primary cause of post-op shivering

A

Pre-operative Hypothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Post-op MI is the strongest predictor of what?

A

Preoperative cardiac morbidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MH: 4 early signs

A

Unexplained increase in ETCO2
Muscle RIgidity
Tachycardia
Increased Temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Respiratory: 4 effects/goals of PEEP

A

Increased FRC by preventing alveolar collapse
Decreased atelectasis and subsequent intrapulmonary shunt
Minimize atelectotrauma
Optimize pulmonary compliance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does Preoxygenation affect oxygen reserve time

A

Provides a patient with roughly 5-8 mins of oxygen reserve
Up to 90% of FRC (2L) is filled with oxygen
Normal O2 demand is around 200-250 ml/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Respiratory: effects of volatile agents

A

Dose-Dependent depression of ventilation
Decreased TV (Causes decreased MV)
Increased RR
Resp. drive response to hypoxemia is abolished at MAC >1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

NS contents

A

Equal parts NS and Cl (154 mmol/L each)
Osmolarity 308 (Isotonic)
pH: 4.5-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Intraop Monitoring: 1 twitch (TOF monitoring)

A

Single pulse delivered at 1-0.1 HZ (Every 1-10 seconds)
Each Stimuli lasts .2msec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Positioning for a nephrectomy

A

Lateral flexed position

Axillary roll is placed beneath the dependent upper chest to minimize risk of brachial plexus injury

This position is associated with adverse respiratory and circulatory effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ASA Standard Monitoring

A

NIBP Cuff
Temp
EKG
SPO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Most commonly injured nerve in Lithotomy position

A

Common Peroneal (Fibular)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Trendelenburg positioning effects on the lungs

A

Decreased FRC
Decreased Lung Compliance
Significant Atelectasis
Increased peak airway pressure (Can lead to barotrauma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What NMB causes Histamine release?

A

Succinylcholine
Atracurium
Mivacurium
Gantacurium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Low-Dose Dopamine Dose

A

0.5-3 mcg/kg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Low-Dose Dopamine Effects

A

stimulates D1 receptors; causes vasodilation of renal vasculature/promotes diuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Moderate Dose Dopamine

A

moderate doses (3-10 mcg/kg/min)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Moderate Dopamine Effects

A

stimulates beta-1 receptors; causes inc. myocardial contractility, HR, SBP, and CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

High Dose Dopamine

A

high dose (10-20 mcg/kg/min)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

High Dose Dopamine Effects

A

stimulates alpha-1 receptors; inc. PVR and dec. renal blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

most commonly injured nerves during patient positioning

A

ulnar nerve and brachial plexus
-due to arms out > 90º or falling off armboard (more of a concern in deep trendelenburg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what patient position is directly associated with increased intraocular AND intracranial pressure

A

Steep Trendelenburg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

lithotomy position: common procedures and physiological effect

A

-commonly used for GYN, urology, and rectal procedures
-dec. FRC/lung compliance
-inc. venous return and CO when raising legs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

recovery from NMBs: head lift time

A

At least 5 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

cardiovascular: effects of volatile agents

A

-dec. BP
-dec. SVR (except halothane)
-dec. CO (except isoflurane and minimally by desflurane)
-cardiac protective effects via ischemic preconditioning
-N2O has no cardiovascular effects!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

positioning: posterior fossa

A

craniotomy of the posterior skull
-can be done in prone or beach-chair position
-mayfield pins are used (causes acute inc. in BP when pins are positioned)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

intraop monitoring: 10 physiologic effects of hypothermia

A

-cardiac arrhythmias and ischemia
-inc. PVR
-LEFT shift of Hgb-O2 saturation curve
-reversible coagulopathy (platelet dysfunction)
-inc. post-op protein catabolism and stress response
-altered mental status
-impaired renal function
-delayed drug metabolism
-impaired wound healing
-inc. risk of infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

lithotomy position: considerations when positioning and common complications

A

-flex legs 90º and abduct 30º at hip joint

-raise/lower legs at same time to avoid lumbar torsion

-common complications: common peroneal nerve injury and venous thrombosis due to obstructed venous drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Advantages of Rocuronium

A

-suitable alternative to succ for RSI
-no metabolism and eliminated primarily by liver–> no active metabolite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

intraop monitoring: 6 causes of ETCO2 increase

A

-hypoventilation
-rebreathing of CO2
-iatrogenic administration of CO2 (ex. from lap insuflation)
-bicarbonate administration
-tourniquet release
-sepsis or other hyper metabolic conditions (fever, MH, thyroid storm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

LR Contents

A

-Na (130) > Cl (109) > lactate (28) > K (4) > Ca (1.4)

-osmolarity: 273 (isotonic)

-pH: 6-7.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

at what platelet count is transfusion indicated

A

-normal patients < 10,000-20,000
-thrombocytopenic patients < 50,000

-1 unit inc. platelet count by approx. 5,000-10,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

positioning: axillary roll

A

placed BELOW the axilla/armpit to protect brachial plexus
-supports the thorax and prevents compression of lower arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

IV fluids with transfusion

A

crystalloids or colloids can be infused simultaneously through a second IV line for volume replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

succinylcholine side effects with defasciculating dose of NDNMB

A

helps prevent fasciculations and dec. post-op myalgias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

pulse ox law

A

pulse oximetry is based on Lambert-beer law

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Lambert-Beer Law

A

oxygenated and deoxygenated hemoglobin differ in their absorption of red and infrared light: oxyhemoglobin absorbs more infrared light (940nm) and deoxyhemoglobin absorbs more red light (660 nm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

5 Patient risk factors for positioning

A

-thin or morbidly obese
-dec. blood flow: vascular diseases (smoking) , ischemia, and hypotension
-advanced age (dec. mobility)
-diabetes
-long procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

central line positioning

A

optimal location of catheter tip is just superior to or at junction of the superior vena cava and right atrium

40
Q

most commonly injured nerve in lateral decubitis position

A

brachial plexus (protect w/ axillary roll!!)

-also radial and common peroneal

41
Q

cardiovascular: effects of desflurane

A

rapid inc. in desflurane conc. can cause transient (but sometimes worrisome) inc. in HR, BP, and catecholamine levels

42
Q

plasmalyte contents

A

-Na (140) > Cl (98) > acetate (27) > gluconate (23) > K (5) > Mg (1.5)

-osmolarity: 295 (isotonic)

-pH: 4-8 (7.4)

43
Q

succinylcholine hyperkalemia

A

-serum potassium inc. by 0.5 mEq/L
-this can be catastrophic in pt’s with preexisting hyperkalemia: burn injury, massive trauma, severe chronic infection, and neurological disorder (stroke, Parkinson’s, etc., muscular denervation, muscular dystrophy)

44
Q
A
45
Q

Remifentanil Half-Life

A

approx. 3 minutes regardless of infusion duration (lacks context sensitivity)

46
Q

How is remifentanil metabolized

A

Rapid degradation by plasma esterases

47
Q

When are bite blocks required

A

needed in prone position to secure ETT or any surgery in which MEPs are monitored

48
Q

Hypokalemia on an EKG

A

-inc. P wave height/peaked
-prolonged PR interval
-prolonged QT
-shorter and flattened or inverted T wave
-ST depression
-U waves

49
Q

Describe this ECG

A

Hypokalemia

50
Q

Describe this ECG

A

Normokalemia

51
Q

Prone position risks

A

Post-op blindness (ischemic optic neuropathy)

52
Q

prone position effects on ventilation

A

Improved ventilatory effect
increased FRC

53
Q

Prone position cardiac effects

A

Decrease in Cardiac Output, venous return, and LV Compliance

54
Q

4 Body heat loss routes

A

Radiation
Convection
Evaporation
Conduction

55
Q

Which body heat loss route is most common

A

Radiation

56
Q

Which body heat loss route is 2nd most common?

A

Conduction

57
Q

How does the epinephrine dose change which receptor will be effected?

A

Small doses are going to agonize Beta 2
Medium Doses will agonize Beta 1
Large doses will agonize Alpha and Beta

58
Q

Small Dose Epi

A

1-2 mcg/min

59
Q

Small dose epi receptor

A

Beta 2 Agonist

60
Q

Medium Dose EPi

A

4 mcg/min

61
Q

Medium Dose Epi Receptor

A

Beta 1 Agonist

62
Q

Large Dose EPi

A

10-20 mcg/min

63
Q

Large Dose Epi Receptor

A

Alpha and Beta agonist

64
Q

What can cause Pulse Oximetry interference?

A

Methemoglobinemia
Methylene Blue dye use
Other artifacts

65
Q

Methemoglobinemia effects on SpO2

A

Carbon Monoxide poisoning can result in methemoglobinemia, causing a false 85% reading on the SPO2 monitor

66
Q

How does methylene blue affect SpO2 readings

A

Blue dye causes falsely low readings

67
Q

What artifacts can affect SpO2

A

Excessive ambient light
Motion
Low perfusion

68
Q

What 4 ECG Artifacts can simulate arrhythmias?

A

Patient or lead wire movement
Electrocautery use
60-hz interference from nearby alternating current devices
Faulty electrodes

69
Q

What is a common cause of mainstem intubation?

A

Happens during patient positioning because increased head flexion causes increased tube depth

70
Q

What does mainstem intubation present as?

A

Increased PIP
Decreased Saturation
No change in ETCO2

71
Q

When must an arterial line be zeroed?

A

Any time the patient is moved if the patient is not moved in tandem

72
Q

Where should an arterial line be zeroed?

A

At the body level that is being monitored:
ex. at ear level to measure cerebral/circle of willis Pressure

73
Q

True or false: Transducer measurements in arterial lines are static

A

False
They drift over time.
Zeroing should be done regularly

74
Q

Parkinson’s Comorbidities

A

HTN, ischemic heart disease, musculoskeletal disorders, HLD, and diabetes
(plus psychiatric comorbidities: depression, sleep disorders, cognitive impairment anxiety)

75
Q

Medications contraindicated in Parkinson’s patients

A

Avoid metoclopramide/reglan, anti-dopaminergic drugs, and succinylcholine (more susceptible to hyperkalemia)

76
Q

How do we check recovery from NMBs?

A

Sustained Tetany for 5 sec
Sustained head life for 5 sec
Inspiratory force (At least -25cm H2O)
Vital Capacity
Tidal Volume

77
Q

What 11 things will LOWER MAC?

A

hypothermia
Hyperthermia
Elderly
Acute alcohol use
Anemia Hct<10
Hypoxia (PaO2<40)
Hypercarbia (PaCo2>95)
MAP <40
Hypercalcemia
Hyponatremia
All anesthetic drugs except ephedrine
Chronic Amphetamine use

78
Q

Core Temp Monitoring Goals

A

Maintain temp >=36 C

79
Q

What is the gold standard for Core temperature monitoring

A

Pulmonary Artery

80
Q

Core Temp Locations

A

Pulmonary Artery Catheter
Distal Esophagus
Nasopharyngeal
Tympanic Membrane

81
Q

What properties about desflurane would make it a good mask induction agent?

A

low solubility in blood and body tissue cause very rapid induction and emergence

82
Q

What properties of Desflurane make it a bad induction agent?

A

pungency, airway irritation, and inc. airway resistance in children w/ reactive airway susceptibility (associated w/ more coughing, breath-holding, and laryngospasms)

83
Q

Anticholinesterase (Like Neostigmine) side effects

A

SLUDGE BB
Salivation
Lacrimation
Urination
Defecation
GI Upset
Emesis
Bronchoconstriction
Bradycardia

84
Q

4 Consequences of intra-op Hypothermia

A

Increased Cardiovascular morbidity
Increased risk of wound infection (Dec. temp 1.9C triples incidence of wound infection
increased risk of bleeding
Prolonged anesthesia recovery time

85
Q

Considerations that must be taken into account for patients in NORA for MRI Procedures

A

-must exclude all ferromagnetic materials from magnet area
-all anesthesia equipment must be compatible with the scanner
-patients must be free of implants that could interact with the magnet (ex. pacemaker)

86
Q

use and disadvantage of ECG monitoring filters

A

used to reduce “motion” artifact
-lead to distortion of the ST segment and may impede diagnosis of ischemia

87
Q

train of four Hz

A

2 Hz (4 stimuli in 2 secs, each for a 200 microseconds/.2 msec duration)

88
Q

increased resistance to succinylcholine occurs in what instances?

A

-myasthenia gravis (or any condition associated w/ fewer ACh receptors)
-dibucaine-resistant variant allele (or any pt w/ abnormal pseudocholinesterase genes)

89
Q

succinylcholine termination of action

A

metabolized by pseudocholinesterase into succinylmonocholine in plasma and liver

90
Q

MAC anesthetic requirements by age

A

dec. by 6% per decade of age

91
Q

Which 2 leads are used for ECG ischemia detection

A

-mainly V5 (anterior and lateral wall ischemia)
-lead II (arrhythmias mainly, but also inferior wall ischemia)

92
Q

4 consequences of shivering

A

Increased O2 consumption by 200%
Increased sympathetic activation
increased intracranial and intraocular pressure
Aggravate wounds from stretching

93
Q
A
94
Q
A
95
Q
A
95
Q
A
96
Q
A

Anesthesiologist Assistant (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions