Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Bioscience II > Exam 3 YSKs > Flashcards

Exam 3 YSKs Flashcards

1
Q

Above what age is considered an ASA-2?

A
  • 65
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the elevated age-related risks with anesthesia related to?

A
  • Agre related disease have a more important role than the age alone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the two types of depression?

A
  • Long-term endogenous

- Short-term reactive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the symptoms of short-term reactive depression?

A
  • Poor appetite
  • Weight-loss
  • Agitation
  • Recurrent thoughts of suicide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Distinguish dementia from delirium.

A
  • Permanent

- Progressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the cardiovascular physiological changes associated with aging?

A
  • Reduced arterial compliance (Increased afterload and LVH)
  • Diastolic BP unchanged or decreased
  • CO typically declines
  • Decreased HR (Increase in vagal tone, decreased adrenergic sensitivity)
  • Increased dysrhythmias
  • Decreased cardiac reserve (exaggerated after decreased in BP after anesthesia)
    Prolonged circulatory time (prolonged drug effect time)
  • Diminished response to hypovolemia, hypotension, hypoxia (less increase in HR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What effect does aging have on VAA and why?

A
  • Faster induction

- Less CO- Less uptake- Less “whisking away”- faster alveolar build-up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

During what stage of anesthesia care is ventilatory impairment most common with the elderly?

A
  • PACU

- Ensure good oxygenation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What physiological age-related changes are seen in the renal system?

A
  • Renal blood flow decrease
  • Kidney mass decrease (number of glomerulus is 1.2 million)
  • Tubular length decrease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What changes are seen with creatinine and BUN in the aging kidney?

A
  • Creatinine does not change
  • BUN gradually increases
  • There is a decrease in muscle mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What physiological hepatic and GI changes are seen in the elderly?

A
  • A decrease in esophageal and intestinal motility

- Decreased gastroesophageal sphincter tone (increased risk for pulmonary aspiration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What age-related changes are seen in the CNS?

A
  • Cerebral blood flow decrease

- Decrease in brain mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Do geriatric patients require higher or lower dose of local and general anesthetic?

A
  • Reduced doses of each
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What age-related changes that affect regional anesthesia in geriatrics?

A
  • Reduced dose requirements

- But may need to dose more frequently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What can changes can be expected from spinal anesthesia in geriatrics?

A
  • A longer duration of action can be expected

- Varying states of an acute state of confusion postoperatively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the general pharmacologic considerations in geriatrics?

A
  • Decreased volume of distribution (increased total body fat, decreased total body water) for water-soluble drugs
  • Elimination half-life increased (decreased hepatic and renal blood flow)
  • Altered plasma protein binding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What happens with mean alveolar concentration in geriatrics?

A
  • Decreased MAC

- Approximate 4% decrease every decade after 40 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a major cardiovascular effect of VAA in the elderly?

A
  • Exaggerated myocardial depressant effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the dose requirements of nonvolatile anesthetic agents in geriatrics?

A
  • Lower dose requirements

- Benzos accumulate in fat stores, VOD is larger, elimination is slowed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the age-related pharmacologic changes with muscle relaxants?

A
  • Decreased CO, prolonged onset
  • Decreased renal clearance, delayed recovery
  • ** Decreased hepatic clearance, elimination half-life and duration of action prolonged
  • Decreased plasma cholinesterase, prolonged Succinylcholine effect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is an important GI consideration in the management of the geriatric patient?

A
  • Beneficial to attempt to increase gastric pH and decrease gastric volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What can be expected with spinal anesthesia in the elderly?

A
  • More sensitive to spinal anesthesia
  • Prolonged duration of action
  • Exaggerated drop in BP (ensure fluid volume)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the purpose of the endocrine system?

A
  • Works with the nervous system to regulate homeostasis
  • Regulates:
  • Behavior
  • Growth
  • Metabolism
  • Fluid status
  • Development
  • Reproduction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How are endocrine glands distinguished from exocrine?

A
  • Secrete their hormone products into surrounding extracellular fluid
  • Surrounding by extensive vascular network
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are some important endocrine glands?

A
  • Pituitary gland
  • Thyroid gland
  • Parathyroid gland
  • Adrenal gland
  • Pancreas
  • Ovaries and testes
  • Placenta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is endocrine function mediated by?

A
  • Hormones
  • “signaling molecules”
  • Transmission of a hormonal signal through the bloodstream to a distant target cell, often over long distances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe paracrine function

A
  • Hormone signal acting on a neighboring cell of a different type
  • Cover short distances
  • Alpha and Beta cells in the pancreas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Describe autocrine function

A
  • Secreted hormones act on the producer cell itself or on neighboring identical cells of an identical type
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the three major categories of hormones?

A
  • Proteins or peptides (most in body)
  • Amines or amino-acid derivatives
  • Steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are some major peptide or protein hormones?

A
  • Insulin
  • GH
  • Vasopressin
  • Angiotensin
  • Prolactin
  • EPO
  • Calcitonin
  • Somatostatin
  • ACTH
  • Oxytocin
  • Glucagon
  • PTH
  • Synthesized in endocrine cells, processed by the cell and stored in secretory granules within the endocrine gland
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are some major sites of hormone degradation and elimination?

A
  • Liver
  • Kidneys
  • A small amount of degradation occurs at the target cell itself
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Describe hormone receptor activation:

A
  • Hormone receptors either on the surface of cells or inside cells
  • Every hormone has a specific onset and duration of action
  • Hormonal effects may be generated in seconds minutes or several hours to days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the relationship between the amount of hormone receptor to circulating hormone?

A
  • Hormone receptor number is usually inversely related to to the concentration of the circulating hormone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the three control mechanisms of hormones?

A
  • Neural (evoke hormone secretion according to stimulation
  • Biorhythms (Circadian)
  • Feedback mechanisms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Describe positive feedback mechanisms:

A
  • Hormone A causes more of hormone A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Describe negative feedback mechanisms:

A
  • Limits or terminates hormone secretion once a response has occurred
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Describe the pituitary gland:

A
  • Hypophysis, known as the master gland
  • Secretes hormones with far-reaching effects on homeostatic, developmental, metabolic, and reproductive functions of the body
  • A small endocrine gland located on the base of the brain
38
Q

What is anatomically significant about the pituitary gland?

A
  • Connected to the overlying hypothalamus by the hypophyseal stalk
39
Q

What are the six primary hormones of the anterior pituitary lobe?

A
  • GH (promotes skeletal body growth and protein/carb metabolism)
  • ACTH (Regulate growth of adrenal cortex; regulates cortisol androgenic hormones and skin pigment)
  • TSH (growth and metabolism of thyroid gland, controls most systems of body)
  • FSH (spermatogenesis in males, follicle development in females)
  • LH (Induces ovulation, corpus luteum stimulation, stimulates testosterone production in testes)
  • Prolactin (Produces mammary gland development and milk production)
40
Q

What is a major perioperative consideration during surgery of the anterior pituitary gland?

A
  • May require thyroid hormone replacement and corticosteroid coverage in the perioperative period
  • May have DI (administer vasopressin)
41
Q

What conditions lead to the secretion of GH?

A
  • Stress
  • Hypoglycemia
  • Exercise
  • Deep sleep
42
Q

What symptoms are related to hypersecretion of GH?

A
  • Overgrowth of internal organs
  • Lung volumes increase (V/Q mismatch)
  • Limited exercise tolerance
  • Cardiomyopathy
  • HTN
  • Accelerated atherosclerosis can lead to symptomatic cardiac disease (CHF, dysrhythmias, aortic aneurysms)
43
Q

What ECG findings may present with hypersecretion of GH?

A
  • Often show LVH
  • Conduction defects
  • ST-wave depression
44
Q

What is the aim of acromegaly treatment?

A
  • Restoring normal GH levels

- Micro resection of anterior pituitary tumor

45
Q

What are the two important peptide hormones of the posterior pituitary?

A
  • ADH

- Oxytocin

46
Q

Where are the hormones of the posterior pituitary synthesized?

A
  • ADH largely synthesized in the supraoptic nucleus
  • Oxytocin in the paraventricular nucleus
  • Neither is synthesized in the posterior pituitary itself
47
Q

What is the primary purpose of ADH?

A
  • Increase urine osmolarity
  • Decrease serum osmolarity
  • Increase blood volume
  • Urine concentration/vascular dilution
  • Collecting ducts impermeable to water reabsorption without ADH
  • ADH promotes hemostasis
48
Q

What triggers the secretion of ADH?

A
  • Increase in plasma osmolarity or plasma sodium ion concentration
  • Decreased blood volume
  • Decreased BP
  • The osmotic threshold for ADH release is 285mOsm/L
  • Decreased blood volume or blood pressure provokes ADH release
49
Q

What occurs with deficient ADH?

A
  • DI
  • Polyuria
  • Serum concentration ( >290mOsm/L)
  • hypernatremia ( >145mEq/L)
50
Q

What occurs with the hypersecretion of ADH?

A
  • SIADH
  • Plasma hypotonicity ( <270 mOsm/L)
  • Dilutional hyponatremia ( <130 mEq/L)
  • Water intoxication
  • Brain edema
51
Q

What percentage of calcium is bound to plasma proteins and what percentage is ionized and in blood?

A
  • 40% protein-bound

- 60% ionized and circulating in blood, portion that exerts effect

52
Q

What portion of Ca++ exerts physiologic effects?

A
  • Ionized Ca++
53
Q

What is normal serum Ca++ concentration?

A
  • 8.5-10.5 mg/dL
54
Q

What is normal ionized Ca++

A

1.1-1.23

55
Q

What effect does alkalosis have on Ca++ concentration

A
  • Decreases ionized Ca++
56
Q

What effect does acidosis have on Ca++ concentration?

A
  • Increases ionized Ca++

- But decrease in plasma Ca++?

57
Q

What is the most important Ca++ regulator and what are its’ triggers?

A
  • PTH
  • Decreases in plasma Ca++ stimulate PTH secretion
  • Increases in plasma Ca++ inhibit PTH secretion
58
Q

What is the endocrine role of Vitamin D?

A
  • Augments intestinal absorption of Ca++
  • Facilitates action of PTH on bone
  • Augments renal absorption of calcium in distal tubules
  • Lack of Vitamin D (by low UV light) effects Ca++
  • 99% of Ca++ stored in bone
59
Q

What is the relationship between PTH and Mg+ and Phosphatemia?

A
  • Hyperphosphatemia and acute hypomagnesemia stimulate PTH secretion
  • Ca++ and Phosphate have inverse relationship
60
Q

What are the ECG findings related to hypercalcemia?

A
  • Cardiac conduction disturbances
  • Shortened Q-T interval
  • Prolonged P-R
61
Q

Describe the treatment for hypercalcemia:

A
  • Rehydration followed by brisk diuresis
  • Biphosphonate or calcitonin administration
  • Administer 40-80mg of lasix, calciuresis
  • Treat underlying cause
62
Q

What are the anesthetic considerations involved with hypercalcemia?

A
  • Serialized monitoring of Ca++, Mg+, and K+
  • Avoid hypovolemia and acidosis
  • Invasive monitoring may be necessary
  • Unpredictable responses to anesthetic agents
63
Q

What are the ECG findings found with hypocalcemia?

A
  • Prolonged Q-T interval
  • Delayed ventricular repolarization
  • Predisposed to ventricular dysrhythmias
64
Q

How much insulin does the pancreas normally produce daily?

A
  • 50-60 Units
  • Half gets eliminated with the first-pass effect
  • 25-30 Units gets delivered peripherally
65
Q

Describe the control of insulin secretion:

A
  • Ingestion increases insulin secretion
    Plasma insulin levels increase 30-60 minutes after meal (5-10 fold)
  • Plasma glucose most important stimulator of insulin release, directly activate B-cells for insulin synthesis and secretion
  • Low plasma glucose inhibits this response
  • Amino acids also potent stimulators of insulin release
66
Q

What is the most important role of glucagon?

A
  • Enhance hepatic glucose output and increase plasma glucose
67
Q

What are the major stimulators of glucagon release?

A
  • Epinephrine
  • Cortisol
  • GH
    • Infection
    • Hypoglycemia
    • Toxemia
    • Severe injury
    • Surgery
68
Q

What is the diagnostic fasting glucose level for diabetes?

A
  • 126
69
Q

What are the major distinguishing factors behind Type I DM?

A
  • Less than 10%
  • Absolute deficiency of insulin
  • Dependent on exogenous insulin
70
Q

What are the major distinguishing factors behind Type II DM?

A
  • 90% of DM
  • Impaired insulin secretion
  • Peripheral insulin resistance
  • Both
71
Q

Describe the anesthetic management of the patient with DM:

A
  • Most common endocrine disorder in surgical patients
  • High morbidity and mortality in the perioperative period
  • Schedule case earlier in the day
  • Target BG is 120-140 pre-operatively
  • Oral hypoglycemics increase the risk for intraoperative hypoglycemia
72
Q

What is a major advantage of RA in the operative care of the diabetic patient?

A
  • Produces less deleterious changes in glucose homeostasis
73
Q

The universal goal for perioperative blood glucose is:

A
  • BG= 120-140
74
Q

What is the treatment for hypoglycemia in the surgical patient?

A
  • 25mL of 50% glucose

- Blood glucose of 40-60 produces mild symptoms of hypoglycemia

75
Q

Which thyroid hormone is more abundant in the body?

A
  • T4

- T3 is more potent and less protein bound

76
Q

What are the physiologic effects of thyroid hormone?

A
  • Increase in metabolism
  • A rise in O2 consumption…
  • CO2 production
  • HR and contractility increase
  • Increase in minute ventilation
77
Q

Describe the clinical manifestations of hyperthyroidism:

A
  • Weight loss
  • Heat intolerance
  • Muscle weakness
  • Diarrhea
  • Hyperactive reflexes
  • Nervousness
  • Fine tremor
  • Exophthalmos
  • Goiter
  • Cardiac signs, particularly w/ Grave’s Disease (CHF= work-up thyroid disease) (Sinus Tach, A.fib.)
78
Q

Describe the intraoperative anesthetic considerations with hyperthyroidism:

A
  • Avoid drugs that stimulate the SNS (Pancuronium, Ketamine)
  • Patients typically on inderal/propranolol
  • Induction agent of choice is thiopental
  • **Patients may be hypovolemic and vasodilated
  • No change in MAC levels in patients with hyperthyroid
79
Q

What is the most serious postoperative threat in patients with hyperthyroidism and how does it manifest?

A
  • Thyroid storm
  • Hyperpyrexia
  • Tachycardia
  • Altered consciousness
  • Hypotension
  • Tx. consists of: hydration, cooling, esmolol or propranolol,
80
Q

How do you distinguish thyroid storm from MH?

A
  • No muscular rigidity

- Marked acidosis

81
Q

What are the postoperative risks associated with hyperthyroidism?

A

Subtotal thyroidectomy is associated with a number of postoperative risks:

  • Recurrent laryngeal nerve palsy (One nerve results in hoarseness, two nerves can result in stridor)
  • Hematoma formation
  • Hypoparathyroidism
  • Pneumothorax
82
Q

What are the clinical manifestations of hypothyroidism?

A
  • Weight gain
  • Cold intolerance
  • Muscle fatigue
  • Lethargy
  • Constipation
  • Hypoactive reflexes
  • Dull facial expression
  • Depression
  • CV manifestation
  • Pleural, abdominal, pericardial effusions, decreased myocardial contractility,
  • Cool and mottled extremities
  • Decreased CO and SV
83
Q

Describe myxedema coma:

A
  • Extreme hypothyroidism
  • Impaired mentation
  • Hypoventilation
  • Hypothyroidism
  • Hyponatremia
  • CHF
  • More common in elderly after surgery or trauma
84
Q

Describe the anesthetic considerations with hypothyroidism:

A
  • Pts. more susceptible to hypotensive effects of anesthetic agents, diminished CO
  • Potential complications:
  • Hypoglycemia
  • Anemia
  • Hyponatremia
  • Large tongues= difficult intubation
  • Hypothermia
  • Blunted baroreceptor, decreased CO
  • ** Delayed recovery from GETA, may be ventilated post-op for longer
85
Q

What is produced in the adrenal cortex?

A
  • Mineralcorticoids (Aldosterone), Glucocorticoids (Cortisol), androgens,
86
Q

What is produced in the adrenal medulla and in what proportion?

A
  • Dopa
  • Epi (80%)
  • Norepi. (20%)
87
Q

What is the major function of aldosterone?

A
  • Causes sodium to be reabsorbed in the distal renal tubule in exchange for K+ and H+ ions
  • Net effect= reabsorption of water
88
Q

What’s an important consideration of adrenalectomy and glucocorticoid deficiency?

A
  • Stress dose of corticosteroid

- 100mg hydrocortisone q 8 hrs.

89
Q

What are the clinical manifestations of catecholamine excess?

A
  • Headaches
  • HTN
  • Sweating
  • Palpitations
90
Q

What are the anesthetic considerations in the care of the patient with catecholamine excess?

A
  • Assessment should focus on the adequacy of adrenergic block and volume replacement
  • Treat intraoperative HTN w/ Cardene or Phentolamine, NOT a B-Blocker
  • Post-resection may need Neo or Levo drip, watch for volume overload

Bioscience II (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions