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Adv. Princ 3 > Exam 3 12-22(24) > Flashcards

Exam 3 12-22(24) Flashcards

1
Q

Definition of an aortic aneurysm compared to when surgical intervention is required?

A

a 50% increase in diameter compared with normal or > 3cm in diameter.
Surgical intervention is required if greater than 5.5cm

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2
Q

Type 2 Crawford scale aneurysm, the perioperative risks include?

A

paraplegia and/or renal failure following surgery.

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3
Q

Diagnosis of an abdominal/thoracic aneurysm… tell me about US and MRI?

A

US is very sensitive for AAA (detected as a pulsatile abdominal mass during routine examination)

MRI IS THE MOST ACCURATE

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4
Q

Aneurysm causing hoarseness is due to?

A

stretched left RLN

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5
Q

In a patient with aneurysm what is the test that is the most important predictor of renal failure post op?

A

CMP

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6
Q

which is more important in the patient with an aortic or thoracic aneurysm, monitoring or anesthetic drugs?

A

proper monitoring is more important

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7
Q

aortic aneurysm cross clamping, which arm do you monitor?

A

monitor right arm (left arm occlusion)

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8
Q

Thoracic aorta unclamping leads to what hemodynamic changes?

A

massive decrease in SVR and CO

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9
Q

What is the most effective measure for protecting the kidneys
from ischemia produced during cross clamping?

A

maintain circulating blood volume

mannitol BEFORE clamping may be useful

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10
Q

largest and most important artery to the spinal cord?

A

artery of adamkiewicz

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11
Q

Duration of aortic cross clamping determines the risk of paraplegia, when does ischemia risk increase?

A

greater than 30 min.

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12
Q

what type of complication during aneurysm treatment is the leading cause of mortality?

A

cardiac complications (MI and Heart Failure)

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13
Q

Who gets an EVAR?

A

aneurysms > 5.5 cm and complicated Type B dissections

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14
Q

What type of intervention does aortic dissection require?

A

immediate surgical intervention if it is ascending dissection

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15
Q

What initiates the event of an aortic dissection?

A

tear in the intima

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16
Q

when do around half of all aortic dissections occur in women under 40?

A

3rd trimester of pregnancy

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17
Q

causes for an aortic dissection?

A

smoking
HTN
deceleration injury
Iatrogenic (aorta cannulation, cardiac cath., cross clamping, aortic manipulation and arterial incision)

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18
Q

which type of dissections are considered surgical emergencies?

A

(DeBakey 1 or 2 or Stanford A)

Involves ascending aorta

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19
Q

are descending dissections surgical emergencies?

A

often managed medically, surgical repair does not always produce better results.

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20
Q

Diagnosis of dissection can be done with?

A

TEE

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21
Q

How do aortic dissecting patients present?

A

Present with acute, severe, and sharp pain in anterior chest, neck, or between shoulder blades

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22
Q

A major cause of death with an aortic dissection is cardiac tamponade, how does that occur?

A

due to retrograde dissection into sinus of Valsalva with rupture into pericardial space

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23
Q

The basilar artery terminates and divides into what?

A

2 posterior cerebral arteries

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24
Q

20% of CO supplies the brain through what arteries?

A

internal carotid arteries and vertebral arteries that join and form the basilar artery

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25
Q

what arteries join to form the circle of wills?

A

anterior, middle, and posterior cerebral arteries

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26
Q

what is subclavian steal syndrome?

A

occlusion of stenosis of the subclavian or innominate artery, this causes reversal of flow (retrograde) though the opposite vertebral artery, the reverse flow diverts blood away from the brain and into the supply of the arm!

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27
Q

S/S of subclavian steal syndrome?

A

absent or diminished pulse in the ipsilateral arm, SBP 20 mmHg lower in that arm.

Bruit over subclavian artery

Central nervous system ischemia, syncope, vertigo, ataxia, and hemiplegia

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28
Q

what is achalasia?

what are the symptoms?

how is it diagnosed?

treatment?

anesthesia concerns?

A

neuromuscular disorder of the esophagus.

dysphagia, regurgitation, heart burn, and chest pain

esophagram (Bird beak test)

mainly palliative: nitrates and CCB to relax LES; dilation; esophagectomy

Treat as a full stomach (RSI), large bore NGT to evacuate the esophagus prior to induction, awake intubation

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29
Q

Acute pancreatitis is most often caused by what two things?

A

gall stones and alcohol abuse

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30
Q

MCC of chronic pancreatitis?

A

chronic alcohol abuse

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31
Q

amylase differences with acute and chronic pancreatitis?

A 
acute = elevated
chronic = usually normal
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32
Q

where do most GI bleeds originate?

A

UPPER GI tract due to peptic ulcer disease

33
Q

what may clue you into the fact that a patient with a GI bleed has a Hct below 30%?

A

orthostatic hypotension

34
Q

BUN levels in a GI bleeder?

A

typically greater than 40mg/dl due to absorbed nitrogen from blood into small intestine.

35
Q

upper airway protection for upper GI bleed?

A

ETT preferred

36
Q

urea breath test, what indicates you have H.Pylori (which causes PUD/Gastritis)

A

the H.Pylori bacteria in your body will turn the urea in the liquid into CO2 and you will have a higher than normal level of CO2 in your breath.

37
Q

What is ALWAYS associated with chronic active gastritis?

A

H.Pylori

38
Q

WHO should not receive mag. or Aluminum containing products and why?

A

(is the answer renal… maybe sever cardiac patients, but I am thinking renal)

39
Q

Cimetidine and Ranitidine bind to what? why does this matter?

A

bind to CYP450 which is a major metabolizer of some anesthetic drugs.
Thus if the patient is on warfarin, phenytoin, or theophylline they need to be monitored for too much of said drug in their system.

40
Q

Treatment for H. Pylori?

A 
Triple therapy for 14 days. 
PPI (double usual dose)
2 ABX (amoxicillin, metronidazole, tetracycline, clarithromycin)
41
Q

PUD… when is it worse and better?

A

burning epigastric pain exacerbated by fasting and made better with meal consumption.

42
Q

MCC of Spinal cord injury?

A

Trauma

43
Q

Major cause of mortality and morbidity from cervical/upper thoracic injuries is ?

A

alveolar hypoventilation combined with inability to clear bronchial secretions

44
Q

Bradycardia with a SCI results from what?

A

loss of T1-T4 sympathetic innervation of the heart

45
Q

Neurogenic shock, what does it do and when does it stop?

A

reduction in BP and untreated can be severe enough to impair organ perfusion.
typically will last 1-3 weeks

46
Q

Can you use Anectine with a spinal cord injury?

A

it is acceptable within the first few hours after injury.

47
Q

what do you want to AVOID with a spinal cord injury (talking hemodynamics)

A

HYPOTENSION

spinal cord perfusion needs to be maintained (IV crystalloids and replace blood loss promptly)

48
Q

What is autonomic dysreflexia? (autonomic hyperreflexia) (internet definition, not PPT)

A

syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in people with spinal cord injuries that involve the thoracic nerves of the spine or above (T6 or above)

is caused by an irritant below the level of injury, including: Bladder: irritation of the bladder wall, urinary tract infection, blocked catheter or overfilled collection bag. Bowel: distended or irritated bowel, constipation or impaction, hemorrhoids or anal infections

49
Q

Chronic SCI… what anesthetic drug will you AVOID?

A

AVOID SUCCINYLCHOLINE

50
Q

PPT definition of autonomic hyperreflexia, what triggers it, and what is it?

A

Cutaneous or visceral stimulation below level of SCI
Surgery and distention of a hollow viscus such as bladder or rectum are common stimuli.

stimulation below level of SCI initiates afferent impulses that enter SC then these impulses elicit an increase in SNS activity along the splanchnic outflow tract

In neurologically intact patients, this outflow would be modulated by inhibitory impulses from higher centers in the CNS, but the presence of a SCI causes this outflow tract to be isolated from inhibitory impulses from above leading to generalized vasoconstriction occurs below level of injury

51
Q

What will you see as the anesthesia provider if autonomic hyperreflexia occurs?

A

HTN
REFLEX BRADYCARDIA

(the HTN causes the bradycardia)

52
Q

What occurs above the level of the SCI in autonomic hyperreflexia?

A

vasodilation above the level of injury.

nasal stuffiness due to vasodilation

may have HA with blurred vision

53
Q

likelihood of having autonomic hyperreflexia?

A

more likely if the SCI is ABOVE T6 = 85% likely to happen.

if Below T10 then unlikely to happen

more likely to occur with a complete lesion compared to incomplete lesion

54
Q

which is less effective in not causing AH in a SCI patient… epidural or spinal?

A

epidural is less effective than spinal, thus AH more likely to occur with an epidural compared with a spinal.

55
Q

If a SCI patient has AH what med should immediately be available to treat the HTN?

A

Vasodilator with a short half life such as nitroprusside.

56
Q

orthostatic intolerance syndrome occurs most often in what patient population?

A

young women

57
Q

Cardioinhibitory reflex occurs in 80% of patients, what is it?

A

mediated by the Vagus nerve and produces profound bradycardia

58
Q

Vasodepressor reflex occurs in 10% of patients, what is it?

A

; mediated by inhibition of vasomotor tone produces decreases in SVR and profound hypotension

59
Q

what do you use for bradycardia not responsive to drugs?

A

external cardiac pacing

60
Q

Bell’s Palsy (Idiopathic Facial Paralysis) what is it, when does it resolve?

A

Characterized by rapid onset of motor weakness or paralysis of muscles innervated by the facial nerve. (inflammation and edema of facial nerve)

Usually, resolves in 3 months

If recovery has not occurred in 4-5 months, IFP is not the issue

61
Q

is anesthetic technique affected by bell’s palsy?

A

NO

62
Q

Uveoparotid fever, what could that mean?

A

sarcoidosis (which also has facial nerve paralysis in 50-70% of patient’s)

63
Q

Trigeminal Neuralgia (Tic Douloureux) is characterized by?

what age group gets it?

A

Characterized by brief but intense episodes of unilateral facial pain

Stabbing pain in face or mouth that are restricted to one or more divisions of the trigeminal nerve (most often the mandibular region, other regions are ocular division and maxillary division)

typically in late middle age, if occurring in a younger age then suspect MS.

64
Q

What is the most common blood vessel to compress the trigeminal nerve and cause tic douloureux?

A

superior cerebellar artery

65
Q

activation of the trigeminocardiac reflex due to surgery will present as?

A

bradycardia

66
Q

vagal nerve transection can lead to?

A

development of vocal cord paralysis and may manifest as airway obstruction following tracheal extubation.

67
Q

Patients who have a perioperative stroke are eight times more likely to die within 30 days of surgery. Because of this, elective surgery should be delayed for how long?

A

at least 9 months following a stroke

68
Q

patient has MS, do you want to use GA with sux, epidural or spinal?

A

epidural is the best choice

69
Q

mannitol will have an onset of how long? and will reach peak effect in how long?

A

onset is 30 min.

peak is 2 hours

70
Q

if someone is on levadopa you will cont. its use perioperative, in what amount of time can you see skeletal muscle rigidity if levadopa was stopped?

A

6-12 hours

71
Q

what can cause an exacerbation of MS? (anesthetic drugs, temp increase, temp drop?)

A

an increase in body temperature of 1 degree C.

72
Q

If someone has intracranial hypertension can you use a spinal? (what about epidural, hypoxia, hypercarbia?)

A

spinal is acceptable as the amount used is small enough that it should not have a significant effect on the intracranial hypertension. BUT with an epidural the volume is large enough that you should not. hypoxia and hypercarbia both increase pressure in the head so avoid that.

73
Q

Upon emergence from general anesthesia, a patient exhibits torticollis. The patient has no known previous history of the disorder. What agent would be the most appropriate first-line treatment?

A

Benadryl 25-50mg IV

74
Q

A patient has been diagnosed with an ischemic stroke. Which agent should be avoided in the care of this patient?

A

Glucose bc hyperglycemia has been associated with poor outcomes in patients with ischemic stroke

75
Q 
•	Mr. Jones has recently been diagnosed with Amyotrophic Lateral Sclerosis.  The SRNA should know that which of the following drugs should be avoided during induction of anesthesia?
A) Fentanyl 
B) Propofol 
C) Ketamine
D) Succinylcholine
A

Succinylcholine

76
Q

• A 47 year old female presents to the hospital with hyperpigmented skin, scoliosis, cutaneous lipomas, and clubfoot. Which of the following best describes these patient’s signs/symptoms?

A

tethered spinal cord syndrome

77
Q
  1. In the setting of autonomic disorders, changes in catecholamine release and adrenergic receptor density may occur. Therefore, one should titrate the dosage of _____ and avoid the use of _____?
A

Direct-acting adrenergic agonists, Indirect-acting adrenergic agonists

78
Q
  1. Succinylcholine should be used with caution in patients w/ neurologic diseases affecting the peripheral nervous system because of risk of hyperkalemia resulting from _____?
    a. Down regulation of acetylcholine receptors at the neuromuscular junction
    b. Upregulation of acetylcholine receptors at the neuromuscular junction
    c. A deficiency of pseudocholinesterase
    d. An excess of pseudocholinesterase
A

B. upregulation

Adv. Princ 3 (4 decks)

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