Critical Care/Anesthesia

Question 1

What is the most common cause of acute pulmonary insufficiency in the immediate postoperative period?

Answer 1

Atelectasis and edema

Question 2

Hemodynamic findings in hypovolemic shock?

Answer 2

Low PCWP, depressed CO, elevated SVR, low venous O2

Question 3

Normal values for PCWP, CO, CI, SVR, PAP, RVP, and venous O2?

Answer 3

nl PCWP = 6-12
nl CO = 5
nl CI= 2.5-4.5
nl SVR = 1000-1500
PAP: 25/10
RVP: 25/4
nl venous O2 sat = 70

Question 4

Hemodynamic values in cardiogenic shock?

Answer 4

High PCWP, depressed CO, elevated SVR, and low venous O2

Question 5

Hemodynamic values in septic shock?

Answer 5

Normal PCWP, high CO, low SVR, slightly high venous O2

Question 6

Hemodynamic values in neurogenic shock?

Answer 6

low PCWP, low CO, low SVR, low venous O2

Question 7

What are effects of excessive carb administration via TPN?

Answer 7

• hyperglycemia and DKA
• excessive insulin production leading to rebound hypoglycemia if TPN discontinued
• failure to wean from the vent 2/2 increased CO2 production from breakdown of carbs

Question 8

Steps in RSI?

Answer 8

1) Preoxygenation
2) opioid–fentanyl
3) sedative–etomidate
4) paralytic–succinylcholine

Question 9

What are hemodynamic findings in LHF

Answer 9

High PCWP (>18)

Question 10

What are hemodynamic findings in tamponade?

Answer 10

Equalization of diastolic pressures in the heart

Question 11

Hemodynamic findings in hypovolemic shock>

Answer 11

High PVR and low diastolic P in the heart

Question 12

Hemodynamic findings in early septic shock>

Answer 12

Low SVR but nl CI 2/2 compensation with tachycardia

Question 13

What is vital capacity?

Answer 13

The amount of air that can be exhaled after max inspiration, = inspiratory capacity + expiratory reserve volume

Question 14

What is inspiratory capacity?

Answer 14

Tidal volume + inspiratory reserve volume

Question 15

What is total lung capacity?

Answer 15

VC + residual volume

Question 16

Dopamine targets which receptors?

Answer 16

DA1/DA2 agonist at low doses (increases renal blood flow and therefore UOP), beta agonist at moderate doses (increases cardiac output and contractility), alpha agonist at high doses (peripheral vasoconstriction).

Question 17

Which anesthetic gas has the least myocardial depression?

Answer 17

Nitrous oxide

Question 18

What vasopressor to use in neurogenic shock?

Answer 18

Phenylephrine (peripheral vasoconstriction)

Question 19

What maneuver has been proven to improve ARDS outcomes?

Answer 19

increasing PEEP

Question 20

Which reflexes may still be present in brain death?

Answer 20

Spinal reflexes such as limb withdrawal

Question 21

What is the equation for arterial oxygen content? What is the most important factor?

Answer 21

=1.34 x Hgb x SaO2 (O2 sat). Most important is Hgb,

Question 22

What are sxs and tx for CO2 embolus?

Answer 22

Sxs: sudden drop in end tidal CO2. Tx: DC pneumoperitoneum, place patient in L lateral decub, aspirate from CVL in R atrium, and hyperventilate

Question 23

3 stages of ARDS?

Answer 23

1) exudative–protein rich edema moves into alveolar spaces. Leukocytes proliferate and cause lung injury.
2) fibroproliferative–fibrosis and collagen formation
3) remodeling

Question 24

Initial tx for adrenal insuff in patient with chronic steroid use?

Answer 24

IV dexamethasone 4 mg

Question 25

How is succinylcholine degraded?

Answer 25

Pseudocholinesterase in the plasma

Question 26

How is pancuronium cleared?

Answer 26

Kidney

Question 27

How is rocuronium cleared?

Answer 27

Liver

Question 28

How is cisatracurium cleared?

Answer 28

Hoffman degradation in the blood, therefore can be used in renal and hepatic failure

Question 29

What are side effects of succinylcholine?

Answer 29

hyperK and malignant hypertension

Question 30

What is obesity hypoventilation syndrome?

Answer 30

caused by alveolar collapse from chest wall compression, can lead to pulm HTN and RHF. Patients are both hypoxic and hypercapneic.

Question 31

What is the antidote for benzo overdose and what is the dose?

Answer 31

Flumazenil, 0.2 mg IV. Can give up to 3 mg.

Question 32

What is the antidote for beta blocker overdose?

Answer 32

Glucagon

Question 33

What is the sensory pathway for the gag reflex?

Answer 33

Glossopharyngeal nerve (CN IX) via sensation to the upper epiglottis

Question 34

What is sensory supply of 1) epiglottis 2) larynx above cords 3) larynx below cords

Answer 34

Upper epiglottis: glossopharyngeal nerve (gag reflex)
Lower epiglottis and larynx above cords: internal branch of superior laryngeal nerve (cough reflex, branch of vagus)
Larynx below cords: recurrent laryngeal nerve