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Anesthesia Oral Board Exam > Differential Diagnoses > Flashcards

Differential Diagnoses Flashcards

1
Q

Hypoxia

A 
A). Low inspired O2 concentration
B). Hypoventilation
     -apnea
     - obstruction
     - trauma
      - mechanical causes (disconnection)
C). Shunt - V/Q mismatch
   - atelectasis
   - mucous plugs
   - pneumo-/hemo-/chylothorax
   - pleural effusion
   - endobronchial intubation/ OLV
   - pulmonary edema
   - pneumonia/pneumonitis
   - aspiration
   - bronchospasm
   - pulmonary embolism
   - inhibition of hypoxic pulmonary vasoconstriction (HPV)
   - decreased MvO2
   - intracardiac shunt
   - pulmonary artery-venous fistula
   - during one long ventilation
D). Increased diffusion barrier 
    - pulmonary edema
    - pneumonia
    - fibrosis
E). Baseline condition
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2
Q

Hypercarbia

A 
A). Increased production
   - MH (malignant hyperthermia)
   - Serotonergic Syndrome
   -shivering
   -seizure
   -Thyroid storm
   -sepsis
   -fever
   -excessive carbohydrate intake
   -Reperfusion Syndrome
   -bicarbonate administration
   -release of tourniquet or aortic crossclamp
B)  Decreased Elimination
   1). Hypoventilation:
    -iatrogenic; drug induced (sedatives, NMB); high spinal; phrenic nerve palsy; vent settings; OLV; retractors; permissive hypercapnia)
    - patient:  central, COPD, CHF, pneumothorax, increased intra-abdominal pressure; airway/ETT obstruction; pulmonary edema
  2). Rebreathing
   - incompetent inspiratory/expiratory check valve
   -exhausted soda lime 
  3). Inadequate flow with Mapleson system
  4). Increased dead space ventilation:
  - pulmonary edema
  - COPD
  - Endobronchial ETT
C). CO2 use
   - Laparoscopy
   - pH stat with CPB
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3
Q

Difference between Malignant Hyperthermia vs. Neuroleptic Malignant Syndrome vs. Thyroid Storm

A

All have hypercarbia, hyperthermia, and tachycardia, however…

  • MH has respiratory acidosis and/or lactic acidosis, hyperkalemia, elevated CK, and rigidity typically NOT associated with Thyroid Storm. Tx with Dantrolene
  • Thyroid Storm is associated with HYPOkalemia and usually presents postoperatively
  • Neuroleptic Malignant Syndrome (NMS) mental status changes occur over 1-3 days and is associated with dopamine blocking agents (e.g. Haloperidol, olanzapine, metoclopramide, droperidol, etc.). Tx with Dantrolene, bromocriptine, amantadine.
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4
Q

Differential diagnoses for wheezing

A

Lower airway vs. Upper airway

Lower airway:

  • kinked tube
  • mucous plug
  • herniated cuff
  • foreign body
  • endobronchial intubation
  • pneumothorax
  • bronchospasm
  • pulmonary embolism
  • cardiogenic
  • anaphylaxis
  • aspiration
  • Carcinoid
  • Baseline condition

Upper airway:

  • laryngeal edema
  • laryngospasm
  • laryngomalacia
  • foreign body
  • vocal cord paralysis
  • infection
  • tumor
  • polyps
  • baseline condition
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5
Q

Differential diagnoses for Hypotension

A 
Hypoxia
Hypercarbia (very late)
Dysrhythmia
- bradycardia
- tachycardia
- non sinus rhythm
- asystole
- Pacemaker failure

Decreased afterload

  • vasodilation
  • hypovolemic shock
  • septic shock
  • anaphylactic shock
  • neurogenic shock (high spinal or cord injury)

Decreased preload

  • all types of shock noted above
  • aortic crossclamp or unclamping
  • pneumothorax
  • embolism (pulmonary, air, fat, amniotic fluid)
  • IVC occlusion
  • tamponade (high airway pressures)

Impaired myocardial function:

  • ischemia
  • acidosis
  • hypocalcemia
  • cardiomyopathy
  • electrolyte disorder ( hypocalcemia)
  • valvular disease
  • congenital heart disease
  • vegetation or myxoma
Carcinoid crisis
Addisonian crisis
Drug effect
Erroneous value
Baseline condition
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6
Q

Addisonian Crisis vs Carcinoid Crisis

A

Addisonian crisis:

  • hyperthermia
  • tachypnea
  • tachycardia
  • hypotension

Carcinoid Syndrome

  • skin flushing
  • diarrhea
  • tachycardia
  • shortness of breath
  • diarrhea
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7
Q

Hypertension

A 
A). Artifact
   - small cuff
   -lowered a-line transducer
B). Patient
   -light anesthesia
   -pain
   -withdrawal
   -rebound hyperalgesia
   -Pheochromocytoma (epi, norepi)
   -Hyperthyroidism (Thyroid storm)
   -Autonomic hyperreflexia (stimulation below level of spine injury)
   -Neuroleptic Malignant Syndrome (NMS)
   -Serotonergic Syndrome
   -HTN
   -increased ICP
   -Renal artery stenosis
   -elevated aldosterone
   -pre-eclampsia/ eclampsia
   -drugs (cocaine, ephedra, PCP, etc)
C). Iatrogenic
   -light anesthesia
   -drugs
   -aortic cross clamp
   -Malignant Hyperthermia
   -ECT/ seizure
   -overload (?)
   -hyperalgesia (?)
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8
Q

Hypotension

A 
A). Artifact
   -large cuff
   -elevated a-line transducer
B)  Preload
   -NPO
   -diuretic
   -bowel prep
   -dialysis
   -nausea/vomiting/diarrhea
   -bleeding
   -regional anesthesia (sympathectomy)
   -spinal shock
   -release of aortic cross clamp
   -CPB (initiation)
   -pneumothorax
   -dynamic hyperinflation
   -intrauterine pregnancy
   -laparoscopy
   -abdominal compartment syndrome
   -PE/VAE
   -cardiac tamponade
   -diastolic dysfunction
C). Heart 
   -dysrhythmia (Brady/tachy)
   -PPM failure
   -neohepatic
D). Contractility
   -+/- drug
   -hypoxia/hypercarbia
   -CAD
   -cardiomyopathy (restrictive/obstructive)
   -LVF/RVF
   -HYPOcalcemia, HYPERmagnesemia, acidosis
   -post-CPB
   -IABP/VAD malfunction
   -Adrenal insufficiency (Addison's disease)
E). SVR
   -sepsis
   -anaphylaxis
   - +/- drugs
   -vasoplegia: CPB, anaphylactic, proteins, ACEIs, cytokine release, Pheo resection
   -initiation of CPB
   -anemia
   -brain death
   -spinal shock
F). PVR
   -baseline
   -protamine
   -hypoxia/hypercarbia
   -acidosis
   -PE/VAE/FE
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9
Q

Tachycardia

A 
A). Artifact
    -count T wave
B). Patient
   -hypercarbia/hypoxia
   -reflex with hypotension/hypovolemia
   -withdrawal
   -light anesthesia
   -pain
   -hyperalgesia
   -Pheochromocytoma
   -Hyperthyroidism
   -Autonomic hyperreflexia
   -NMS and Sertonergic Syndrome
   -drugs
   -anemia
C). Iatrogenic
   -aortic cross clamp
   -MH
   -seizure/ ECT
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10
Q

Bradycardia

A

A) Patient
-hypoxia/hypotension
-ischemia
-elevated ICP
-vagal (valsalva, uterine inversion)
-carotid sinus manipulation
-spinal shock
-autonomic hyperreflexia (reflex response)
-HTN (reflex response)
-electrolytes (hyperkalemia, hypocalcemia)
-PPM failure
-dysrhythmia (heart block)
-congenital cardiomyopathies
-infectious (Lyme diphtheria, typhoid)
-endocrine (hypothyroidism)
-autoimmune (SLE)
-Athlete
-fetal
B). Iatrogenic
-drugs (digoxin, neostigmine, beta blockers, CCBs, opioids, phenylephrine, clonidine, amiodarone, organophosphates, inhaled anesthetics-halothane)
-high spinal
-Bezold-Jarisch Reflex (decreased RA volume leads to decreased HR)
-oculocardiac reflex
-severe hypothermia
-Hering-Breuer reflex (pulmonary stretch receptors)
-VAE (initially tachycardia)
-Fetal Combined Spinal-epidural reflex (sudden release of maternal pain and reduction in circulating catecholamines leads to unopposed uterine constriction causing fetal distress briefly

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11
Q

Postpartum Bleeding

A
  • Uterine atony (most common cause)
  • retained placenta
  • uterine inversion
  • ## genital trauma
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12
Q

Antepartum Bleeding

A
  • placenta previa
  • abruptio placenta
  • uterine rupture
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13
Q

Physiological changes in pregnancy

A

1) . Airway:
- engorged and increased friability of nano/oropharyngeal mucosa
2) . Respiratory:
- increased minute ventilation
- decreased FRC
- tidal volume increases (due to diaphragmatic excursion)
- ABG shows slightly decreased PaCO2 (32 mmHg) with compensatory decrease in HCO3 (22 mmHg) = pH 7.44
- rightward shift of Ox-Hgb dissociation curve (P50 = 30)
3) . Cardiac
- LVH (seen by 12 wks gestation)
- Grade I or II early or mid-systolic murmur (likely TR)
- increased CO
- increased HR
- increased SV (stroke volume)
- slight decrease in BP
- aortocaval compression
4) Hematologic
- increased blood volume yet decreased Hct (55% increased plasma volume and 30% increase in RBC volume)
- Increased Factors 1, 7, 8, 9, 10, and 12 inducing hypercoaguable state; Factors 11, 13, and Antithrombin 3 decreased.
- decreased plasma proteins (25% decreased plasma cholinesterase
5) . GI
- upward displacement of stomach
- decreased LES
- increased pH of gastric fluids
6) . Renal
- RBF increases; GFR increases
7) . Endocrine
- increased sensitivity to insulin (predisposes to DM) glucose tolerance impaired
- increased thyroid size due to follicular hyperplasia and vascularity
8) . Neuromuscular
- decreased MAC
- distention of vertebral plexus reduces epidural and intrathecal spaces

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14
Q

Low airway pressure

A

1) . ETT –>patient
- extubation
- de-/under inflated cuff
- ruptured cuff
- Tracheobronchial disruption
- Bronchopleural fistula
- OG tube in trachea

2) . Machine —> ETT
- low tidal volumes
- circuit leak
- machine leak/malfunction

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15
Q

High Airway Pressure

A

NOT Pulmonary Embolism (PE)

  • pulmonary edema
  • pneumonia
  • pneumothorax/hemothorax/chylothorax
  • bronchospasm
  • obstruction: secretions, blood, foreign body, laryngospasm, kink or clog in ETT, hematoma
  • atalectasis
  • mainstem/OLV
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16
Q

Oliguria

A

A). Post-Renal

  • foley kinked
  • clot

B). Pre-Renal (FeNa <1)

  • low CO/BP
  • Hypovolemia
  • Aortic cross clamp
  • Nonpulsatile

C). Renal

  • ischemia
  • vasospasm
  • nephrotoxins
  • emboli
  • cytokines
  • reperfusion injury
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17
Q

Jaundice

A

A). Prehepatic

  • Hemolysis: acute hemolytic transfusion reaction or delayed
  • Hematoma reabsorption
  • increased unconjugated = indirect bilirubin

B). Post-hepatic

  • cholestatic: stones, inflammation, stenosis
  • pancreatitis
  • increased conjugated = direct bilirubin

C). Hepatic -hepatocellular disease

  • chronic disease/ infectious (e.g. viral hepatitis)
  • ischemic
  • Drug-induced (acetaminophen, alpha methyldopa, isoniazid, sulfonamides, chloramphenicol, halothane)
    - Gilbert’s disease: most common cause of idiopathic hyperbilirubinemia (unconjugated = indirect bilirubin)
  • Crigler-Najjar syndrome: rare form of severe unconjugated hyperbilirubinemia due to decreased or absent glucoronyl transferase; could lead to early death
  • Dubin Johnson syndrome: decreases transport of organic ions from hepatocytes to the biliary system, producing a conjugated hyperbilirubinemia
  • Fatty liver of pregnancy
  • TPN
  • Reperfusion injury
  • Intrahepatic cholestasis
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18
Q

Delayed arousal

A
  • Patient sensitivity to drugs
  • hypoxia/hypercarbia/hypotension
  • ischemia
  • cerebral edema
  • drugs: opioids, benzodiazepines, NMR, propofol, inhaled anesthetics
  • CVA: intracranial hemorrhage, subarachnoid hemorrhage, venous sinus thrombosis
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19
Q

Things to do to decrease elevated ICP

A

1) . drain CSF
2) . hyperventilate (?)
3) . hypertonic saline > mannitol ; lassie
4) . elevate head of bed
5) . avoid hypoxia
6) . hypothermia (?)

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20
Q

Post-op stridor

A

1) . inadequate reversal of muscle relaxants
2) . hematoma
3) . bilateral RLN injury
4) . laryngospasm (secondary to hypocalcemia can be seen >24 hrs post-op)
5) . airway edema
6) . laryngomalacia
7) . residual anesthetic

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21
Q

Ruling out cervical spine injury

A

1) . Normal level of alertness with
2) . absence of focal neurological deficits
3) . absence of tenderness at posterior midline
4) . No evidence of intoxication
5) . Absence of clinically apparent distraction/injury

CT scan
MRI of cervical spine helps rule out injury

However, SCIWORA (spinal cord injury without radiography abnormality mostly affecting children) may still exist.

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22
Q

Systemic changes in SLE

A

1) . Airway/Respiratory
- pulmonary HTN (can stretch RLN)
- pneumonitis
- fibrosis
- pulmonary embolism
- vocal cord edema/nodules
2) . Cardiac
- pericarditis/myocarditis
- tamponade
- MR/AR
3) Neuro
- psych
4) . Hematologic
- antiphospholipid antibody (hypercoaguable state)
- anemia (Coomb’s positive)
5) . Joint/skin
- rash
- arthritis
- myositis
- oral ulcers
- osteopenia

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23
Q

Cardiac physiology of Aortic cross clamping (afterolad, preload, contractility, perfusion below AoX)

A

1) . Afterload: increases leading to HTN
2) . Preload:
- may INCREASE during SUPRAceliac AoX from redistribution from collapse of splanchnic vasculature
- may DECREASE during INFRAceliac AoX from redistribution of blood to dilated splanchnic vasculature
3) . Myocardial contractility
- may INCREASE (along with an increase in CO) as a result of the increase in after load and preload
- may DECREASE (along with a decrease in CO) as in the case of the myocardium with poor function, causing LV ischemia and failure
4) . Perfusion below the AoX depends on perfusion pressure, NOT preload or CO, raising concerns about excess SNP and suggesting a role for shunting

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24
Q

Physiology of releasing AoX

A

Hypotension due to pooling of blood in distal tissues; ischemia-mediated vasodilation; and release of accumulated vasoactive mediators and myocardial depressant factors

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25
Q

Differential diagnoses for prolonged QT syndrome

A
  • aortic stenosis
  • HOCM
  • WPW
  • myocarditis
  • cardiomyopathy
  • myxoma
  • Brady/tachy
  • congenital heart disease
    a. Romano-Ward (autosomal dominant)
    b. Jervell,Lange-Neilsen (autosomal recessive; assoc. deafness)
  • CAD
  • seizures
  • hyperventilation
  • hypoglycemia
  • Drugs:
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26
Q

Define Systemic Inflammatory Response Syndrome (SIRS)

A

a life threatening dysfunction caused by a dysregulatory response to infection

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27
Q

What is severe sepsis

A

Circulatory and celllular/metabolic abnormalities that are enough to substantially increase mortality with

  • persistent hypotension requiring vasopressor support to maintain a MAP >/= 65
  • serum lactate > 18 mg/dL despite high volume resuscitation
28
Q

Possible complications from TURP syndrome

A
  • Hyponatremia (mental status changes at 120 mEq/L; ST elevations at 115 mEq/L; LOC and seizure
  • Pulmonary edema
  • CV instability (HTN, Hypotension, Vfib)
  • Glycine toxicity (post-op blindness)
  • Perforation
    a. exztraperitoneal (periumbilical/suprapubic/inguinal fullness)
    b. intraperitoneal (N/V, pale, diaphoresis, hypotension, referred shoulder pain)
  • Obdurator Nerve stimulation
  • Hypothermia
  • Bleeding (fibrinolysis from urokinase)
  • Bacteremia, sepsis (6-7%)
29
Q

Drugs that may trigger methemoglobinemia

A

1) . local anesthetics
- Prilocaine (i.e. EMLA)
- Benzocaine (i.e. cetacaine)
2) . metoclopramide
3) . NTG
4) . SNP
5) . Phenytoin
6) . Sulfonamide

30
Q

Treatment for methemoglobinemia

A

1) . Methylene blue (does NOT work in patient’s with G6PD deficiency –>worsens
- 2 mg/kg/5 mins
2) . Ascorbic acid
3) Exchange transfusion ?
4) . Hyperbaric Oxygen

31
Q

Capacity vs. Competence

A

Capacity is your assessement of one’s ability to have sufficient understanding and comprehension

Competence is a LEGAL term assessing a patient’s ability to consent to specific treatment being offered

32
Q

Distinguish SIADH from CSWS

A

Both are associated with HYPOnatremia and a urine osmolality > serum osmolality, however,

  • CSWS is associated with HYPOvolemia and SIADH is not.
  • SIADH has a correction of the low serum uric acid and fractional excretion of uric acid with water restriction
  • SIADH has a greater ADH level
33
Q

Treatment of CSWS vs. SIADH

A

CSWS treatment consists of:

  • fluid and Na+ replacement
  • possible use of fludrocortisone to promote tubular Na+ reabsorption

SIADH treatment consists of:

  • Fluid restriction
  • furosemide
  • democlocycline, which inhibits ADH effect on renal tubules by inducing a nephrogenic DI (given if fluid restriction fails)
34
Q

What is a Cobb angle and how is it relevant?

A

Cobb angle is the angle formed by the 2 perpendicular lines drawn from the lines of the 2 most maximally tilted vertebrae.

  • > 10 degrees is abnormal
  • respiratory impairment is rare < 60
35
Q

What is the Hunt and Hess Classification system?

A

A clinical classification used in assessing intracranial aneurysms:

0: enraptured
I: ruptured with minimal headache
II: moderate-severe HA; no other deficit
III: drowsy/confused or mild focal deficit
IV: stupor, significant hemiparesis, early decerebrate posturing, vegetative disturbances
V: deep coma, decerebrate rigidity, moribund

36
Q

Anesthetic management during an intracranial aneurysm clipping

A

1) . If clipping at the base of the aneurysm
- HYPOtension should be induced prior to clipping

2) . If a temporary clip is being placed on a feeding vessel first to minimize edema downstream,
- then induce HYPERtension

  • Have Nicardipine ready
  • Be ready for massive blood transfusion
37
Q

When is vasospasm most likely to occur in regards to an intracranial aneurysm repair?

A

Post-op day 3-14

38
Q

Expected FEV1 and FEV1/FVC ratio in COPD

A

decreased FEV1 and FEV1/FVC ratio

39
Q

PFTs in restrictive Lund disease vs. obstructive

A

Restrictive

  • decreased volumes and capacities
  • normal flow rates
  • normal FEV1/FVC ratio
40
Q

Qualities of a difficult intubation on physical exam

A 
Mouth
   -long incisors
   -overriding incisor
   -interincisor distance
   -short uvula
   -oral aperture
Jaw
   -prognath jaw
   -short submandibular space
   -noncompliant submandibular space
Neck
   -short neck length
   -large neck circumference
   -decreased ROM
41
Q

Causes for difficult ventilation (MOANS)

A
  • Mask difficult (beard, blood)
  • Obesity (BMI >30) / obstruction
  • Age >55
  • No teeth (edentulous)
  • Stiff lungs/ chest wall
  • etc.: tonsils, polyps, trauma
42
Q

What blocks are required for an Awake FOB?

A

1) . Oropharynx = Trigeminal nerve (V)
2) . Posterior Hypopharynx = Glossopharyngeal (IX)
3) . Vagus(X) = SLN & RLN

43
Q

What is Cytokine Release Syndrome?

A

occurs with administration of antithromboglobulin (ATG) used as an immunosuppressant in renal transplants

-a cause of hypotension

44
Q

Diseases associated with Malignant Hyperthermia

A

1) Central Core Disease (#1) - infancy hypotonia; linked to chromosome 19q13
2) . King-Denborough syndrome (short stature, mental retardation, prox. weakness, cryptorchidism, webbed neck, low set ears, and scoliosis)
3) . Myotonia congenital
4) . Schwartz-Jampel syndromes (dwarfism, craniofacial, and skeletal abnormalities, stiffness, blepharophimosis)
5) . Osteogenesis imperfecta

45
Q

How does the pediatric airway differ from that of an adult?

A

1) . The head and tongue are larger
2) . the nasal passage is smaller
3) . the larynx is more cephalic, more anterior airway
4) . cricoid cartilage is the narrowest part of the airway
5) . epiglottis is long and stiff
6) . deciduous teeth may be loose
7) . airways are smaller
8) . the upper airway muscle are more sensitive to anesthetics

46
Q

Why is the neonate more sensitive to anesthesia?

A
  • less protein binding
  • increased permeability of the BBB
  • decreased drug elimination
  • increased sensitivity to drugs
47
Q

Fire Triad

A

1) . Oxidizer (oxygen, nitrous oxide)
2) . Ignition (laser, heated probe, FOB, electrocautery, defibrillator pads)
3) . Fuel (ETT, nasal cannula, surgical catheter, sponge, drape, EtOH, ether, acetone, hair dressing, endoscope, etc)

48
Q

Reasons an epidural test dose can fail?

A

1) . patient is on a beta blocker
2) . elderly do not readily generate tachycardia
3) . patient could have a contraction

49
Q

Goal CPP in patients with suspected increased ICP

A

Normal CPP = 50
Goal CPP = 60-70

Do not go above 70

50
Q

Things to do to decrease ICP

A

1) . drain CSF
2) . hyperventilate (?)
3) . Hypertonic Saline > Mannitol; Lasix
4) . Elevate HOB
5) . Avoid hypoxia
6) . Hypothermia (?), STP (methohexital)
7) . Avoid hyperglycemia

51
Q

Post-dialysis Disequilibrium Syndrome

A

slight cerebral edema causing delirium post-dialysis

52
Q

Drugs to avoid giving in Breastfeeding mothers

A

1) . Hydromorphone (11 x more potent than Morphine)
2) . Codeine
3) . Gabapentin (neonatal sedation at large doses)

53
Q

What are some physiologic complications of liver cirrhosis

A 
A). Respiratory
   -decreased FRC (from ascites)
   -increased AV shunts (hepatopulmonary syndromes)
   -pleural effusions
   -inhibition of HPV from vasodilating substances (i.e. ferritin, vasoactive intestinal peptide, glucagon)
   -hypoxemia
B). Cardiovascular
   -systemic AV shunts
   -HYPERdynamic state - increased CO from low SVR state and low viscosity; high output CHF may occur; mixed venous O2 may be high (as seen in sepsis)
C). GI
   -portal HTN
   -ascites
   -GI bleeding (esophageal varies)
   -Hemorrhoids
   -Aspiration risk
D). Hematologic
   -thrombocytopenia, neutropenia from splenic sequestration
   -anemia
   -coagulopathy
E). Renal
   -Na+ retention
   -Hepatorenal syndrome (pre-renal oliguria with Na retention, azotemia, and ascites) FENa+ < 1
   -impaired free water clearance
   -decreased renal perfusion
F). Neurologic
   -Encephalopathy
G). Metabolic
   -HYPOnatremia (dilutional)
   -HYPOkalemia (due to diuretics or hyperaldosteronism)
   -HYPOalbuminemia
   -HYPOglycemia
H). Spontaneous bacterial peritonitis
54
Q

What is shunted in a TIPSS procedure?

A

Transjugular Intrahepatic Portosystemic Shunt (TIPSS)

Shunt from the portal vein to the hepatic vein, bypassing the liver.

55
Q

What test can be done to diagnose Piriformis Syndrome?

A

A form of back pain that can be illicited by doing the FLAIR maneuver: Flexion, Adduction, Internal Rotation

56
Q

Recommended elective surgery delay with cardiac stents (Angioplasty vs Bare Metal vs Drug Eluting)

A

Angioplasty only: 2-4 weeks
Bare Metal: 4-6 weeks
DES: 6 months to 1 yr

57
Q

Recommended interrogation timeline check for PPM vs. AICD prior to surgery

A

PPM must be interrogated within past year

AICD must have been interrogated within the past 6 months

58
Q

ECG changes seen with HYPOkalemia

A
  • ST segment depression
  • increased QT interval
  • decreased P wave
  • decreased T wave and increased U wave
59
Q

ECG changes in HYPERkalemia

A
  • peaked T waves
  • decreased QT interval
  • widened QRS complex
  • decreased P wave and increased PR interval
60
Q

Define negligence

A

deviation from standard of care

61
Q

Define standard of care

A

what a reasonable and prudent doctor would do

62
Q

What are the components of Liability

A

1) . Duty
2) . Breech of that duty
3) . Harm was done
4) . Causation

63
Q

Angioedema

A

A C1-INH deficiency that leads to elevated protein C levels, which lead to bradykinin release —> edematous airway, GI, and subcutaneous tissues

64
Q

Factors that make a patient an elevated risk for a Major Adverse Cardiac Event (MACE)

A

1) . h/o ischemic heart dz
2) . h/o heart failure
3) . h/o Cerebrovascular disease
4) . IDDM
5) . CRI (creatinine > 2)j
6) Hight risk surgery

65
Q

Complications of Diabetes of a Mother on the Infant

A

1) . Respiratory distress syndrome (RDS),
2) . cardiomyopathy, VSD, ASD, TOGV, 1 umbilical artery
3) . Anencephaly, spina bifida, caudal dysplasia, developmental delay
4) . large or small gestational age; hypoglycemia
5) . hypocalcemia, hypomagnesemia, low iron
6) . increased risk for NEC, anorectal fistula
7) . polycythemia, increased viscosity, low platelets, hyperbilirubinemia
8) . shoulder dystocia, Erb’s palsy, clavicular fx,
9) . renal vein thrombosis, hydronephrosis, genesis

66
Q

Propofol Infusion Syndrome

A

Occurs after administration of high dose propofol over a long period of time (>4 mg/kg/min > 6hrs)

  • unexplained metabolic (lactic) acidosis
  • rhabdomyolysis
  • hyperkalemia
  • hypertriglyceridemia
  • hypotension, refractory bradycardia
  • sudden arrest
  • ARF
  • hepatomegaly
67
Q

Post-op delirium (POD) vs. Post-op Cognitive Dysfunction (POCD)

A

1) . POD is an acute process (0-5 days post-op), with temporary change in orientation and cognition accompanied by:
- fluctuating loss of conciousness
- inattention
- and/or disorganized thinking
- 75% hypoactive
- mechanism: neuroinflammation, cholinergic inhibition, serotonin deficiency, dopamine activation?

2) . POCD is a mild impairment of memory, concentration and information processing after surgery which persists beyond a few days
- usually oder patients in first few months post-op and then resolves
- persists > 3 months in 13% of elderly

Anesthesia Oral Board Exam (1 decks)

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