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Citow Review Book > Critical Care > Flashcards

Critical Care Flashcards

1
Q

How do you calculate Cerebral Perfusion Pressure?

A

CPP = MAP - ICP = (2/3 DBP + 1/3 PP) - ICP

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2
Q

Hypoxia causes _______ of cerebrovasculature.

A

vasodilation

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3
Q

Hypotension leads to _________ of cerebrovasculature.

A

Vasodilation (therefore increased ICP)

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4
Q

What defines a supraventricular tachycardia on EKG?

A

Rate > 100 w/ a QRS < 0.12

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5
Q

Multifocal atrial tachycardia is associated with what disease processes?

A

COPD and Theophylline use

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6
Q

What is the most common reentrant accessory pathway in AV reentrant tachycardia? What is the EKG characteristic? In what disease processes can it be seen?

A

Bundle of KentDelta wavesWolff-Parkinson-White syndrome

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7
Q

What two electrolyte abnormalities are associated with ventricular tachycardia and polymorphic tachycardia?

A

hypokalemia and hyponmagnesia

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8
Q

What EKG findings are seen in digoxin use?

A

gradual downward curve of the ST segment (causes multiple dysrhythmias and AV block)

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9
Q

What EKG findings are seen in hypocalcemia?

A

increased QT interval

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10
Q

What EKG findings are seen in hypothermia?

A

J-point elevation

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11
Q

What EKG changes are seen in Brugada syndrome?

A

right BBB w/ ST eelvation in V1-3

predsiposes to sudden cardiac death

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12
Q

What EKG changes are seen in SAH?

A

peaked T waves and ST depression

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13
Q

What are the classes of Antiarrythmics?

A

Class 1 (Na Channel blockers)

Class 2 (B blockers)

Class 3 (K channel blockers)

Class 4 (Ca channel blockers)

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14
Q

Stimulation of Andrenergic Alpha Receptors leads to ______.

A

vasoconstriction

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15
Q

Stimulation of Andrenergic Beta-1 receptors leads to ______.

A

increases cardiac output (chronotropy) and strength of contraction (inotropy)

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16
Q

Stimulation of Andrenergic B-2 Receptors leads to ______..

A

vasodilation

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17
Q

Activation of dopamine receptors causes ______ of cerebral, renal, coronary, and mesenteric vasculature.

A

vasodilation

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18
Q

What receptors does dobutamine acitvate?

A

B1 agonist, mild B2 and A2 agonist

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19
Q

What are the effects of dobutamine?

A

inotropic, peripheral vascular dilation, increases cardiac output, decrease in SVR

No change in BP

side effect of tachycardia

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20
Q

At low doses, dopamine causes _______ while at high doses it causes ________.

A

vasodilation; vasoconstriction

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21
Q

Phenylephrine affects predominantly _____ receptors.

A

alpha 1

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22
Q

What kind of pressor is vasopressin?

A

norandrenergic

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23
Q

What are contraindications for norepinephrine use?

A

renal failure

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24
Q

What electrolyte abnormality enhances digoxin toxicity?

A

hypokalemia

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25
Q

When therapeutic, what are the effects of digoxin?

A

AV and SA node conduction slowing

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26
Q

What are the treatments for digoxin toxicity?

A

K, Mg, Lidocaine, Digoxin antibody, and charcoal

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27
Q

What are the cardiovascular effects of furosemide?

A

increases SVR and decreases CO

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28
Q

What medication can block the response of furosemide?

A

NSAIDs

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29
Q

What are the major side effects of furosemide?

A

ototoxicity, hypokalemia, hypomagnesemia, hypochloremia, and metabolic alkalosis

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30
Q

What receptors does labetalol act upon? What are its effects?

A

alpha and beta receptors; lowers BP but does not increase HR or increase CO

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31
Q

What is the treatment for methemoglobinemia? What cardiac drug can cause methemoglobinemia?

A

Methylene blue

Nitroglycerine

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32
Q

What cardiac drug can cause cyanide toxicity?

A

Sodium nitroprusside

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33
Q

What are the treatments for air embolism?

A

left lateral decubitus position, hyperbaric oxygen, or removal of air embolism

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34
Q

Describe the Bohr effect. What causes respective right and left shifts?

A

changes in the oxygen dissociation curve to either facilitate oxygen absorption or bonding with hemoglobin.

Right: tissues with decreased oxygen affinity

  • increases in acidity
  • CO2- temperature
  • 2,3-DPG

Left: lung, increased affinity for oxygen
- opposite as above

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35
Q

What is characteristic of ARDS on BAL?

A

high protein levels

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36
Q

B2 agonists have what affect on the respiratory system? What are their potential side effects?

A

bronchodilators

at high doses can cause tachycardia, hypokalemia, or tremors

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37
Q

What is the mechanism of theophylline?

A

increase cAMP

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38
Q

Inhaled anticholinergics include ______ and ______. They cause _______ .

A

Atropine and Ipratropium

decreased parasympathetic input (decreased bronchoconstriction)

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39
Q

What is the duration of vecuronium?

A

30 minutes

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40
Q

What is the duration of pancuronium?

A

1 hour

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41
Q

Succinylcholine is what type of paralytic? What electrolyte abnormality can it cause?

A

depolarizing blocker

hyperkalemia

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42
Q

What is normal tidal volume in adults?

A

5-6 cc/kg

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43
Q

What urine casts are seen in Prerenal conditions?

A

hyaline and finely granular casts

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44
Q

What urine casts are seen in Acute Tubular Necrosis?

A

epithileal and course granular casts

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45
Q

What urine cases are seen in Acute Interstitiial nephritis?

A

white cell casts

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46
Q

What urine cases are seen in Acute Glomerulonephritis?

A

red cell casts

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47
Q

When should dialysis be considered in acute renal failure?

A

K > 6.5, blood pH < 7.1, refractory hypovolemia w/ BUN > 80, Na < 120 or > 155, or overdose of dialyzable drug

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48
Q

Which of the renal tubular acidosis have hyerkalemia and which have hypokalemia?

A

Hyperkalemia: RTA 4

Hypokalemia: RTA 1 and 2

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49
Q

Where do loop diuretics act upon? What is the mechanism?

A

ascending limb of loop of henley

prevent sodium absorption by interfering with Na-K-Cl pump

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50
Q

What is the mechanism of thiazide diuretics?

A

inhibit Na-Cl cotransporter

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51
Q

What are examples of K sparing diuretics? Where do they act?

A

Amiloride, spironolacotone

cortical collecting tubules

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52
Q

Where does mannitol exert its effect?

A

proximal tubule and loop of henley

53
Q

What medication treats neurogenic or atonic bladder?

A

Bethanechol

54
Q

Describe the HR, SVR, CO, and CVP. Cardiac Shock

A

Decreased HRIncreased SVRDecreased COIncreased CVP

55
Q

Describe the HR, SVR, CO, and CVP. Hypovolemic Shock

A

Increased HRIncreased SVRUnchanged/Decreased CODecreased CVP

56
Q

Describe the HR, SVR, CO, and CVP. Septic Shock

A

Increased HRDecreased SVRIncreased COUnchanged/Decreased CVP

57
Q

What acid/base abnormality can occur with massive blood transfusion? What electrolyte abnormalities?

A

Metabolic alkalosis

Hypocalcemia and Hyperkalemia (sometimes hypokalemia secondary to the alkalosis)

58
Q

What causes the reaction seen in febrile nonhemolytic reaction?

A

cytokines (IL-1, IL-6, TNF)

59
Q

What causes transfusion related lung injury? What is it similar to clinically? How does it differ?

A

pulmonary agglutinin reaction

ARDS

resolves in usually 4 days

60
Q

What are the treatments for TTP?

A

plasmapharesis, exchange transfusions, antiplatelet agents, and rarely splenectomy

DO NOT TRANSFUSE PLATELETS

61
Q

What are the treatments for ITP?

A

steroids and splenectomy

62
Q

How long does the platelet effect of ASA last?

A

10 days i.e. the life of the platelet

63
Q

Which coagulation pathway affects PTT?

A

intrinsic

64
Q

Which coagulation pathway affects PT?

A

extrinsic

65
Q

What components make up the intrinsic pathway?

A

XII, XI, iX w/ VIII followed by the shared pathway

66
Q

What components make up the extrinsic pathway?

A

Tissue thromboplastin, VII followed by the shared pathway

67
Q

What is the shared pathway for intrinsic and extrinsic coagulation cascades?

A

X (w/ V) -> IIThrombinI (Fibrinogen) -> Fibrin (w/ XII) -> Stabilized fibrin

68
Q

What coagulation lab measures are affected by DIC?

A

elevated PT, PTT, and bleeding time

69
Q

What is the treatment for DIC?

A
  • treat the causative agent- heparin- cryoprecipitate- platelets- whole blood
70
Q

What are the vitamin K dependent coagulation factors?

A

protein C and S, factors VIII. IX. X. II

71
Q

Hemophilia B is caused by what factor deficiency? What is the genetic inheritance? What are the abnormal lab values? What’s the treatment?

A

factor IX
X-linked recessive
increased PTT, normal PT, normal bleeding time
FFP

72
Q

What is the genetic inheritance of factor VIII deficiency? What’s it called? What is the treatment?

A

X-linked recessiveHemophilia ACryoprecipitate

73
Q

What is the treatment for vWF disease? What’s the treatment?

A

autosomal dominantcryoprecipitate

74
Q

What coagulation factor deficiencies causes hypercoagulablity? What are the clinical manifestations?

A

protein C, S, and antithrombin III

venous thrombosis

75
Q

What is the mechanism of action for heparin?

A

increases the action of antithrombin III

76
Q

What is the reversal agent for heparin?

A

protamine sulfate

77
Q

How do you calculate the expected degree of respiratory compensation for metabolic acidosis and alkalosis?

A

Acidosis: PCO2 = 1.5 x bicard + 8

Alkalosis: PCO2 = 0.7 x bicarb + 20

78
Q

How do you calculate an anion gap?

A

Na - (Cl + HCO3)

79
Q

RTA type 2 causes what type of acidosis? What is the electrolyte lost?

A

normal anion gap metabolic acidosis

HCO3

80
Q

What acid base abnormality can occur from diuretic use? What diuretics classically cause this?

A

metabolic alkalosisloop and thiazide diuretics

81
Q

How does urine osmolality differ between central and nephrogenic DI?

A

Central: < 200 mOsm/LNephro: 200 - 500 mOsm/L

82
Q

Hyperglycemic non-ketotic syndrome can cause what electrolyte abnormality?

A

hypovolemic hypernatremia

83
Q

What are the diagnostic criteria for SIADH?

A

urine osmolarity > serum osmolarity
serium Na < 135
serum osmolarity < 280
urine Na > 20 over 24 hours

84
Q

What are the treatments for SIADH?

A
  • fluid restriction
  • demecoccline (induces nephrogenic DI)
  • furosemide w/ 3%
85
Q

What is the treatment for hyperkalemia w/ EKG changes?

A
  • stabilize cardiac membranes w/ calcium gluconate- insulin- furosemide
86
Q

Where is magnesium absorbed in the nephron?

A

loop of henle

87
Q

What hormone is affected by hypomagnesemia?

A

low parathyroid hormone

88
Q

Blood transfusions can cause what calcium abnormality?

A

hypocalcemia (citrate binding to Ca ions)

89
Q

Hypocalcemia causes what neuromuscular findings?

A

hyperreflexia, tetany, and seizures

90
Q

:Thiamine deficiency causes what abnormalities?

A

berberi heart disease, Wernicke encephalitis, peripheral neuropathy, and lactic acidosis

91
Q

Chromium deficiency causes what abnormality?

A

insulin resistance

92
Q

What element deficiency can impair wound healing and increase infection risks?

A

Zinc

93
Q

What macronutrient should be limited in patients with respiratory failure/COPD?

A

carboydrates (produce highest amount of CO2)

94
Q

What dietary changes help with hepatic encephalopathy?

A

increased branched chain amino acids to decrease aromatic uptake across BBB

95
Q

What test is used to evaluate adrenal insufficiency?

A

ACTH stimulation test

96
Q

How do you distinguish primary vs secondary hypercortisolism?

A

dexamethasone suppression test

97
Q

What are the clinical manifestations of hyperaldosteronism?

A

hypernatremia, hypokalemia, metabolic alkalosis, hypertension, increased urine output

98
Q

What is struma ovarii?

A

functioning thyroid tissue in an ovarian malignancy

99
Q

What is the mechanism of Propylthiouracil?

A

inhibits thyroid hormone synthesis and conversion of T4 and T3

100
Q

What is the most lethal clinical sequela of hypothyroidism?

A

myxedema coma

101
Q

What is MEN I? What is the inheritance pattern?

A

autosomal dominant

tumors of the parathyroid, pancreas, and pituitary gland

102
Q

What is MEN IIa? What is the inheritance pattern?

A

autosomal dominant

parathyroid hyperplasia, medullary thyroid cancer, pehochromocytoma

103
Q

What is the medical treatment for pheochromocytoma?

A

phenoxybenzamine

104
Q

What is MEN IIb?

A

medullary thyroid cancer, pheochromocytoma, mucosal neuromas, intestinal ganglioneuromas, Marfinoid habitus

105
Q

What two common organisms can cause necrotizing fasciatis? What’s the time frame of presentation? What is the treatment?

A

Clostridia and B-hemolytic strep48 hours post oppenicillin and debridement

106
Q

What is the most common cause of meningitis after basilar skull fractures? When does it present?

A

strep pneumo usually occurs within 72 hours

107
Q

What is the most common organism for ventriculoperitoneal shunt infections?

A

staph epi

108
Q

What are the serious side effects of aminoglycosides?

A

ATN (reversible), hearing loss (irreversible), vestibular dysfunction, and worsening of myasthenic syndrome

109
Q

What is the renal side effect of amphotericin B?

A

distal tubule RTA

110
Q

What are the effects of ketamine on CBF, metabolic rate, and ICP?

A

CBF: increasedCMRO2: increasedICP: increased (controversial)

111
Q

Which inhalational anesthetic causes the least increase in CBF?

A

isoflurane

112
Q

What is the side effect of enflurane?

A

lowers seizure threshold

113
Q

What is the effect of thiopental on CBF and CMRO2?

A

decreased both

114
Q

What is the effect of Etomidate on CBF, CMRO2, and CPP?

A

decreased CBF and CMRO2 while preserving CPP

115
Q

What is an important side effect of Etomidate use?

A

suppresses the adrenocortical response to stress

116
Q

What are the effects of fentanyl on CBF and CMRO2?

A

decreases both

117
Q

What anesthetic agents increase CBF?

A

in increasing order:Nitrous oxide, isoflurane, enflurane, ketamine, and halothane

118
Q

What is the antidote for lead poisoning?

A

EDTA, 2,3-dimercaptopropanol (BAL), penicillamine

119
Q

What is the antidote for arsenic poisoning?

A

BAL

120
Q

What is the antidote for mercury poisoning?

A

penicillamine

121
Q

What is the antidote for gold poisoning?

A

BAL and penicillamine

122
Q

What is the antidote for iron poisoning?

A

deferoxamine

123
Q

What is the antidote for organophosphate toxicity?

A

2-puridine aldoxime methochloride (PAM)

124
Q

What is the antidote for tylenol toxicity?

A

N-acetylcysteine (inactivates toxic metabolites)

125
Q

What are the metabolic effect of ASA toxicity?

A

early respiratory alkalosis followed by late metabolic acidosis

126
Q

How is methanol and ethylene glycol intoxication treated?

A

ethanol (saturates alcohol dehydrogenase thus preventing formaldehyde formation)

127
Q

What medications increase or decrease dilantin levels?

A

Increase: cimetidine, warfarin, isoniazid, and sulfa drugs

Decrease: carbamazepine

128
Q

What electrolyte abnormality increases the likelihood of digoxin toxicity?

A

hypokalemia

129
Q

What is the mechanism of Baclofen?

A

GABA agnosit

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