Differentials

Question 1

Tachycardia and hypertension

Answer 1

Pain
Hypoxia
Hypercarbia
hypovolemia
anemia

Question 2

Hypothermias deleterious effects

Answer 2

coagulopathy
cardiac dysrhythmias
impaired renal function
poor wound healing

Question 3

Gradual hypoxia differential

Answer 3

ETT migration
tension PTX
tamponade
fat emboli
allergic reaction
aspiration pneumonitis

Question 4

Normal CI

Answer 4

2.66-4.2

Question 5

Normal PCWP

Answer 5

2-15mmHg

Question 6

Normal PA pressures

Answer 6

15-30/4-12

Question 7

Mixed Venous O2

Answer 7

65-70%

Question 8

PaO2 68mmHg, FiO2 50% and CXR shows bilateral infiltrations: Differential

Answer 8

Aspiration pneumonitis
Cardiogenic pulmonary edema (volume overload)
neurogenic pulmonary edema (from CNS injury)
acute respiratory distress syndrome (ARDS)
TRALI
TACO

Question 9

Berlin Definition of ARDS

Answer 9

1. PaO2/FiO2 ratio of <300
2. Acute onset (within 7 days of inciting event: sepsis, trauma, aspiration, DIC, etc)
3. Bilateral infiltrates on chest CT or CXR
4. Respiratory failure that, in the physician’s best estimation, not fully explained by cardiac failure or fluid overload

Question 10

Mild ARDS

Answer 10

PaO2/FiO2= 200-300

Question 11

Moderate ARDS

Answer 11

PaO2/FiO2= 100-200

Question 12

Severe ARDS

Answer 12

PaO2/FiO2 <100

Question 13

ARDS Tx

Answer 13

• Treat causative events
• Supportive mechanical ventilation should provide sufficient PEEP to recruit collapsed alveoli and improve gas exchange while avoiding high airway pressures, TV 6ml/kg, static airway pressures <30 cmH2O
• Permissive hypercapnia may be necessary to avoid higher TV and airway pressures
• FiO2 < 50% to prevent iatrogenic lung injury
• AVOID STEROIDS–> increased mortality
• inhaled nitric, inhaled prostacyclin, high frequency ventilation, inverse ration ventilation, and prone ventilation have been shown to temporarily improve oxygenation, none have provided significant long term outcome differences

Question 14

CSW vs. SIADH

Answer 14

Both hyponatremic and elevated urine sodium
Differentiated by volume status
CSW: hypovolemia, normal ADH levels, urine sodium levels >100mEq/L
SIADH: euvolemic, elevated ADH, urine sodium not typically >100
Important to distinguish because Tx of SIADH is water restriction, diuresis and demeclocycline (inhibits ADH effects on renal tubules) and Na replacement. Diuresis and water restriction would exacerbate hypovolemia of CSW.

Question 15

STOP BANG

Answer 15

S- loud SNORING
T- daytime TIREDNESS
O- Observed apnea
P- high blood PRESSURE

B- BMI >35kg/m^2 : Obese
A- AGE >50
N- NECK circumference >40cm
G- GENDER: Male

Question 16

STOP BANG Meaning

Answer 16

<3 = low risk
3+ = high risk
5-8= high probability mod-severe OSA

Question 17

Potential complications of moderate-to-severe OSA

Answer 17

Difficult airway management
Aspiration
Bronchospasm
Labile blood pressures
hyperglycemia
difficulty evaluating cardiopulmonary status 2/2 sedentary lifestyle and/or diabetic neuropathy

Question 18

Other morbid obesity potential complications

Answer 18

Patient positioning complications
Rapid desaturation with apnea (decreased FRC)
Obesity hypoventilation syndrome/Pickwickian syndrome
OSA
Post-op apnea
metabolic syundrome
DMII
HTN
CAD
CVA
Altered drug effects
DVT
PE
OA
NAFLD

Question 19

GERD Premeds

Answer 19

H2 Receptor agonist (famotidine, cimetidine)
Metoclopromide (dopamine receptor antagonist)
Non particulate antacid (sodium citrate -bicitra)

Question 20

RCRI

Answer 20

1. IDDM
2. Hx of ischemic heart disease
3. Hx of compensated or prior heart failure
4. Hx of CVA/cerebral vascular disease
5. Renal insufficiency
6. Suprainguinal vascular surgery, intraperitoneal, or intrathoracic surgery

Question 21

PACU Hypoxemia

Answer 21

Airway obstruction 2/2 OSA
Bronchospasm
Resp depression 2/2 narcosis 
aspiration
atelectasis with pulmonary shunting
PE

Question 22

Narcan 1/2 Life

Answer 22

IV narcan= 30-60 minutes

IM narcan 80min- 6hrs

Question 23

Factors that precipitate hemolysis

Answer 23

hypothermia
acidosis
hypoxia
blood products
stress
hyperglycemia
infection
food (fave beans)
chemicals methylene blue and anti malarial
Drugs 
(nitrofurantoin, co-trimoxazole, chloramphenicol)