Critical Care/Post Op Care

Question 1

How do you calculate sodium deficit?

Answer 1

(normal serum sodium - observed serum sodium) x 0.6 x (total body weight)

Question 2

In intrinsic renal failures, what is

• urine osmolality
• urine sodium
• FeNA
• BUN/SCR
• Urine/PCR

Answer 2

urine osmolarity: >500 in Prerenal
urine sodium: >40 –> 2% –> >20 in Prerenal
Urine/PCR ( >40 in Prerenal

Question 3

A change of 10mm Hg CO2 (over 40) results in a change of pH by _____ (from 7.4). Is this an increase or decrease?

Answer 3

A change (both directions) of 0.08 (from 7.4) per 10mm Co2

Question 4

T/F: Spironolactone results in a loss of potassium.

Answer 4

False! It is potassium-sparing

Question 5

Villous adenoma of the colon can result in watery diarrhea and (hypo/hyper)kalemia.

Answer 5

HYPOkalemia

Question 6

Which is associated with hypokalemia: acidosis or alkalosis?

Answer 6

Alkalosis

Question 7

Copper deficiency is characterized by

Answer 7

microcytic, hypochromic anemia

Question 8

Skin lesions similar to enterohepatic acrodermatitis can be seen in which nutritional deficiency? What do these lesions look like?

Answer 8

Zinc deficiency!

= scaly, hyperpigmented lesions over the acral surgaces of elbows and knees

Question 9

Out of the following bodily fluids – saliva, gastric, pancreatic, ileal, colonic – which is most acidic? Which is most basic? Which is most like plasma?

Answer 9

acidic = gastric
basic = pancreatic
most like plasma = ileal

Question 10

How many mEq of sodium in normal saline?

In LR?

Answer 10

NS: 154 Na, 154 Cl, 40 Hco3
LR: 130 Na, 4K, 109 Cl, 28 HCO3

Question 11

What is the succussion splash and what is it used to detect?

Answer 11

Place one hand behind the other on the left abdomen and rib cage and rock the patient between two hands. In PYLORIC OBSTRUCTION, will be able to feel fluid hitting the fingers (splash)

Question 12

What are the most common causes of pyloric obstruction in adults?

Answer 12

Duodenal ulcer and gastric carcinoma

Question 13

T/F: In patients with hypochloremic alkalosis (as in those with pyloric stenosis) whose metabolic abnormalities are refractory to normal saline, 0.1N and 0.2 hydrochloric acid is a safe and effective therapy.

Answer 13

True

Question 14

Once spontaneous bleeding occurs in hemophilia, factor VIII should be transfused until the fraction reaches ___%

Answer 14

30%

Question 15

What is the treatment of hypermagnesemia?

Answer 15

Calcium gluconate or calcium chloride to reverse ECG changes temporarily

Question 16

Which INCREASES ionized calcium: alkalosis or acidosis?

Answer 16

acidosis

Question 17

What is the equation for corrected calcium?

Answer 17

serum calcium + 0.8(4-albumin)

Question 18

How do you calculate serum osmolality? What is normal?

Answer 18

2 (Na + K) + BUN/2.8 + glucose/18

280-300

Question 19

What is the mnemonic for signs and symptoms of hypercalcemia?

Answer 19

Stones (renal stones), Bones (bone pain), Groans (nausea/vomiting, abdominal pain), Thrones (polyuria), and Psychiatric overtones (depression, cognitive dysfunction, coma, anxiety)

Question 20

What is mithramycin used for?

Answer 20

hypercalcemia (but control is temporary; do not use firstline)

Question 21

Which RTA results in loss of bicarbonate? What in loss of acid secretion?

Answer 21

proximal = loss of bicarb
distal = loss of acid secretion

Question 22

T/F: If ristocetin is added to the blood of someone with vWD, their platelets will aggregate.

Answer 22

FALSE! This is partly how vWD can be diagnosed.

Question 23

What is the most common hemostatic disorder inherited by autosomal dominant methods?

Answer 23

von Willebrands Disease

Question 24

ADP, serotonin, and thromboxane A2 are important mediators of platelet aggregation, In the presence of _______________, they cause release of platelet content and their granules, resulting in formation of a platelet plug.

Answer 24

calcium, magnesium, Platelet Factor 4

Question 25

Warfarin-induced skin necrosis happens how long after initiation of therapy?

Answer 25

3-10 days

Question 26

Patients receiving which drugs require higher amounts of Coumadin for therapeutic levels?

Answer 26

barbiturates, OCPs, corticosteroids

Question 27

Why is fibrinolysis seen after surgery on the prostate?

Answer 27

It is rich in urokinase

Question 28

How do you treat fibrinolysis?

Answer 28

Check to see if primary (due to streptokinase, prostate procedures --> urokinase) by checking PT, PTT, and bleeding time/platelet count. These would be elevated in DIC, but not primary fibrinolysis. If NOT elevated, can give aminocaproic acid.

Question 29

A hemolytic transfusion reaction during anesthesia will be characterized by?

Answer 29

bleeding and hypotension

Question 30

Patients with polycythemia vera should receive ___________ for 6 weeks prior to having an elective cholecystectomy.

Answer 30

chlorambucil

Question 31

In TPN, the ratio of non protein foods to nitrogen should be given in which ratio?

Answer 31

100kcal non-nitrogen/ g nitrogen

Question 32

To increase calories via the peripheral route, what should be prescribed?

Answer 32

Fat emulsions (like soybean oil); high dextrose solutions will lead to phlebitis due to hypertonicity of the fluid

Question 33

A patient can be weaned from the ventilator if their vital capacity is >___mL/kg

Answer 33

10-15

Question 34

Successful weaning from ventilation is portended by minute ventilation < ___

Answer 34

10 L/min

Question 35

Successful weaning from ventilation is portended by a tidal volume >___

Answer 35

5 mL/kg

Question 36

Why does sudden cessation of TPN lead to tachycardia and other sympathetic symptoms?

Answer 36

Pancreatic cells upregulate release of insulin while on TPN, so cessation leads to hypoglycemia. Catecholamines are released due to the hypoglycemia.

Question 37

Why can lots of glucose administration (TPN) during surgery lead to increased urine output?

Answer 37

It can cause a hyperosmolar nonketotic coma...all of the osmoles pull water into the vasculature, increasing urine output. Treatment is insulin drip with potassium replacement (insulin will drive potassium intracellularly)

Question 38

Why does excess glucose make it more difficult to wean the ventilator?

Answer 38

Excess glucose = increased production of CO2 = increased ventilatory requirements. Treatment is increase of fat calories (which has a respiratory quotient of 0.7, vs 1.0 like glucose)

Question 39

Old age causes a (left/right) shift in the oxygen dissociation curve.

Answer 39

Left

Question 40

Hormones (cortisol, thyroid, aldosterone) cause a (left/right) shift in the oxgyen dissociation curve.

Answer 40

right

Question 41

____________ is indicated after mismatched blood perfusion to help alkalinize the urine..

Answer 41

IV sodium bicarb

Question 42

____________ are necessary to correct dilutional thrombocytopenia following blood transfusion

Answer 42

Platelet transfusions | 3:1 rbc:plt vs 1:1 severe trauma

Question 43

Potential complications of a PA catheter insertion:

Answer 43

1) transient arrythmias 2) RBBB 3) cardiac perforation 4) PTX

Question 44

The abnormal hemostasis common in renal failure is characterized by which lab abnormality?

Answer 44

Prolonged bleeding time, due to failure of platelets to interact appropriately with vWF. It's corrected with transfusion of cryoprecipitate or by using desmopressin

Question 45

How do you calculate DAILY fluid requirement? Hourly fluid requirement?

Answer 45

DAILY: 100 mL/kg for the first 10, 50 mL/kg for the next 10, then 20 mL/kg for every other 10 after that HOURLY: 4 mL/kg for the first 10, 2 mL/kg for the next 10, then 1 for each after that

Question 46

How does heparin and LMWH help to anticoagulate?

Answer 46

Bind to and accelerate the activity of antithrombin III

Question 47

Which nutritional deficiencies can lead to hyperglycemia?

Answer 47

Chromium: insulin cofactor Manganese: cofactor for enzyme of energy and protein metabolism, as well as fat synthesis (deficiency also leads to hypocholesterolemia)

Question 48

Which clotting factors are especially deficient in plasma?

Answer 48

Factor V, Factor VIII

Question 49

Which coagulation factors are vitamin K-dependent?

Answer 49

factor II, V, IX, X

Question 50

T/F: DIC prolongs PT and PTT, but does not cause hypofigrogenemia.

Answer 50

False, it causes all 3 (along with an increased concentration of fibrin split products)

Question 51

What synthetic colloid can cause hyperamylsemia?

Answer 51

Hetastarch

Question 52

What is the only EKG rhythm that can obscure ST elevations?

Answer 52

LBBB

Question 53

What is the main treatment for candidal sepsis?

Answer 53

amphotericin B

Question 54

What are precipitating factors for sickle cell crisis?

Answer 54

hypoxemia, acidosis