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Final B Flashcards

1
Q

Induction plan for hiatal hernia surgery

A

RSI

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2
Q

Common side effect after gallbladder removal

A

Diarrhea

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3
Q

GI organs in right upper quadrant

A
  • Liver
  • Gallbladder
  • Duodenum
  • Right kidney
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4
Q

GI organs in left upper quadrant

A
  • Spleen

- Pancreas

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5
Q

GI organ in right lower quadrant

A

Appendix

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6
Q

The “upper GU tract” consists of which organ

A

Kidneys

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7
Q

What anatomical features make up the “lower GU tract”

A
  • Ureters
  • Urethra
  • Bladder
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8
Q

Important history in patients with kidney disease

A
  • History of kidney dysfunction
  • History of dialysis
  • Location/function of AV fistula
  • Current medications
  • Daily urine production
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9
Q

What does CHLORIDE stand for when trying to characterize a symptom

A
  • CHaracter of pain
  • Location
  • Onset
  • Radiation
  • Intensity of pain
  • Duration
  • Exacerbating/alleviating factors
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10
Q

What is dysphagia

A

Difficulty swallowing

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11
Q

What is odynophagia

A

Pain with swallowing

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12
Q

What electrolyte abnormalities can be caused by excessive diarrhea? (4)

A

1) Hyponatremia (can’t excrete water due to ADH release)
2) Hypernatremia (if free water loss is not replaced)
3) Hypokalemia (loss of K+)
4) Metabolic acidosis (loss of bicarb)

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13
Q

What is melena? What does it signify?

A

Black tarry stool that signifies upper GI bleed

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14
Q

What is hematochezia? What does it signify?

A

Bright red blood that signifies lower GI bleed

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15
Q

What is jaundice?

A

Yellowish discoloration of skin from increased levels of bilirubin

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16
Q

What is dysuria

A

Pain with urination/difficulty voiding

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17
Q

What is polyuria

A

Increase in 24 hour urine volume

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18
Q

What is nocturia

A

Urinary frequency at night

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19
Q

What are the 4 main types of incontinence

A

1) Urge (overactive bladder)
2) Stress (poor closure of bladder)
3) Overflow (poor contraction/blockage)
4) Functional (medications or health problems)

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20
Q

What is borborygmi

A

Stomach growling

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21
Q

Where should bruits be auscultated for a basic abdominal exam

A
  • Aorta
  • Renal artery
  • Iliac artery
  • Femoral artery
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22
Q

When are bruits normal?

A

When they are confined to systole

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23
Q

How do we assess for peritoneal inflammation

A

Ask patient to cough and determine where the cough produces pain

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24
Q

Pain associated with costovertebral angle tenderness (CVA tenderness) is associated with what

A

Pyelonephritis (kidney infection)

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25
Q

A normal aorta is not more than __ cm wide

A

3

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26
Q

Risk factors for AAA

A
  • Over 65 y/o
  • Smoker
  • Male
  • Family history
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27
Q

What do we assume about a patient coming in for a bowel obstruction who has a history of N/V and feculent emesis

A

Full stomach

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28
Q

Normal albumin levels

A

3.5-5.5g/dL

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29
Q

Albumin levels are a measure of…

A

Hepatic function and nutritional status

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30
Q

Normal AST and ALT levels

A

7-40 U/L

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31
Q

Which aminotransferase is found predominately in the liver

A

ALT

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32
Q

Normal alkaline phosphatase levels

A

25-85 IU/L

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33
Q

When are alkaline phosphatase levels increased?

A
  • Obstructive biliary disease

- Cirrhosis

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34
Q

What test is useful in confirming that elevated ALP is due to liver pathology?

A

5’-Nucleotidase

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35
Q

When is 5’NT test not useful?

A

Later in pregnancy

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36
Q

What are amylase and lipase labs used for?

A

To detect and monitor pancreatic disease

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37
Q

Normal bilirubin levels

A

Less than 1.5mg/dL

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38
Q

What is the most sensitive liver enzyme for detecting biliary obstruction, cholangitis, and cholecystitis?

A

GGTP (gamma-glutamyl transpeptidase)

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39
Q

Normal PT value

A

11-14 seconds

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40
Q

What does PT tests assess for

A

Extrinsic pathway of clot formation

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41
Q

Normal PTT

A

25-38 seconds

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42
Q

What does PTT assess for

A

Intrinsic pathway of clot formation

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43
Q

Coagulation test used in coumadin therapy

A

PT

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44
Q

Coagulation test used in heparin therapy

A

PTT

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45
Q

How does hepatocellular disease affect PT

A

Prolongs PT because the production of coagulation factors by the liver is altered

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46
Q

Why does hepatocellular disease prolong PTT

A

Decreased factor VII

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47
Q

Normal BUN levels

A

10-20mg/dL

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48
Q

BUN levels are an indication of…

A

Renal health

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49
Q

Main causes of an increase in BUN

A
  • High protein diet
  • Decreased GFR
  • Hypovolemia
  • CHF
  • GI hemorrhage
  • Fever
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50
Q

Main causes of a decrease in BUN

A
  • Liver disease

- Inappropriate ADH

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51
Q

Normal creatinine levels in men

A

0.8-1.3mg/dL

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52
Q

normal creatinine levels in women

A

0.6-1mg/dL

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53
Q

A doubling of creatinine levels suggests a __% reduction in GFR

A

50

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54
Q

What does creatinine clearance measure?

A

Glomerular filtration rate

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55
Q

Na+ levels are considered critically low if they are under

A

131mEq/L

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56
Q

Na+ levels are considered critically high if they are over

A

150mEq/L

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57
Q

K+ levels are considered critically low if they are under

A

2.5

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58
Q

K+ levels are considered critically high if they are over

A

5.9

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59
Q

A patient’s stress response to surgery is proportional to what factors? (4)

A

1) Magnitude of injury
2) Total operating time
3) Amount of intraop blood loss
4) Degree of postop pain

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60
Q

What is the most important component of the pre-op evaluation?

A

The patient’s history

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61
Q

How soon before surgery should monoamine oxidase inhibitors be discontinued?

A

2-3 weeks

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62
Q

How soon before surgery should oral contraceptive pills be discontinued? Why?

A

6 weeks due to increased risk of venous thrombosis

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63
Q

How soon before surgery should herbal supplements be discontinued

A

2 weeks

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64
Q

How soon before surgery should aspirin be discontinued

A

7-10 days

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65
Q

How soon before surgery should Thienopyridines (such as clopidogrel) be discontinued

A

2 weeks

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66
Q

How soon before surgery should oral anticoagulants be discontinued

A

4-5 days

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67
Q

Oral anticoagulants are discontinued before surgery to allow INR to reach what level

A

1.5

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68
Q

Major patient risk factors for periop cardiac complications

A
  • MI within 30 days
  • Unstable/severe angina
  • CHF
  • Significant arrhythmias
  • Severe valvular disease
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69
Q

Procedures that are high risk factors for periop cardiac complications

A
  • Emergency surgeries
  • Aortic/major vascular surgeries
  • Prolonged surgeries with large fluid shifts or blood loss
  • Unstable hemodynamic situations
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70
Q

What are METs

A

Metabolic Equivalents of oxygen consumption

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71
Q

Procedure related risk factors of post-op pulmonary complications

A
  • How close the surgery is to the diaphragm
  • Length of surgery (more than 3 hours)
  • General anesthesia
  • Emergency surgery
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72
Q

Patient risk factors for post-op pulmonary complications

A
  • COPD
  • Smoker
  • Over 60 y/o
  • Obese
  • OSA
  • Poor exercise tolerance
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73
Q

Intra-op blood glucose should be kept under

A

180mg/dL

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74
Q

Complications of periop hyperglycemia

A
  • Dehydration
  • Impaired wound healing
  • Inhibition of WBC function
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75
Q

In which procedures do patients not need to alter their anticoagulant regimen

A
  • Dental extractions
  • Arthrocentesis
  • Biopsies
  • Ophthalmic operations
  • Diagnostic endoscopies
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76
Q

Invasive surgery is generally safe from major hemorrhagic complication when the INR is…

A

Below 1.5

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77
Q

How long does it take for the INR to reach 1.5 once oral anticoagulants are discontinued

A

4 days

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78
Q

How long does it take for the INR to reach 2.0 once the oral anticoagulant is re-started postoperatively

A

3 days

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79
Q

How soon before a spinal procedure should Warfarin be discontinued

A

4-5 days

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80
Q

How soon before a neuraxial procedure should a thromboprophylaxis dose of LMWH be stopped

A

12 hours

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81
Q

How soon before a neuraxial procedure should a treatment dose of LMWH be stopped

A

24 hours

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82
Q

SubQ heparin is not a contraindication to a neuraxial procedure if the dose is under…

A

10,000 units

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83
Q

How long should neuraxial needle/catheter insertion be delayed after a dose of IV heparin

A

2-4 hours

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84
Q

What lab test is used to monitor heparin effects

A

PTT

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85
Q

EKG changes associated with hyperkalemia

A
  • Peaked T waves
  • Loss of P wave
  • Sine wave
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86
Q

3 EKG changes associated with hypokalemia

A
  • ST depression
  • Flattened T wave
  • U wave
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87
Q

What part of the EKG is affected with alterations in serum calcium

A

QT interval

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88
Q

How does hypocalcemia affect EKG

A

Prolongs QT interval

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89
Q

How does hypercalcemia affect EKG

A

Shortens QT interval

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90
Q

Arrhythmia associated with prolonged QT

A

Torsades de Pointes

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91
Q

When are Osborn waves seen

A

Hypothermia

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92
Q

How does Digitalis affect the EKG

A

Downsloping ST segment depression

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93
Q

Stages of EKG changes in pericarditis

A

1) ST elevation
2) ST back to baseline
3) T wave inversion

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94
Q

What is hypertrophic obstructive cardiomyopathy?

A

Primary disease of the myocardium where a portion of the myocardium gets thick without any obvious cause

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95
Q

Common EKG changes seen in patients with hypertrophic obstructive cardiomyopathy

A
  • Left axis deviation (due to LVH)

- Q waves in lateral leads

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96
Q

Most common conduction blocks associated with myocarditis

A
  • Bundle branch blocks

- Hemiblocks

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97
Q

EKG changes in a patient with long standing COPD

A
  • Low voltage
  • Right axis deviation
  • Poor R wave progression
98
Q

The S1Q3T3 pattern on an EKG is associated with what?

A

Pulmonary embolus

99
Q

What is the S1Q3T3 pattern?

A

1) Large S wave in lead I
3) Deep Q wave in lead III
3) Inverted T waves in lead III

100
Q

Major EKG change seen in patients with CNS bleed

A

Deeply inverted, wide T waves

101
Q

How does smoking affect the cardiovascular system?

A
  • Increases amount of carbon monoxide attached to hemoglobin, decreasing O2 supply
  • Increases O2 demand
102
Q

Effects of OSA

A
  • HTN
  • Diabetes
  • CV disease
  • Stroke
  • Depression
  • Obesity
103
Q

How soon before surgery is it safe for patients to consume clear liquids

104
Q

How soon before surgery is it safe for patients to consume breast milk

105
Q

How soon before surgery is it safe for patients to consume infant formula

106
Q

How soon before surgery is it safe for patients to consume nonhuman milk

107
Q

How soon before surgery is it safe for patients to consume a light meal

108
Q

How soon before surgery is it safe for patients to consume a fatty meal

109
Q

Effects of muscle relaxants on patients with myasthenia gravis

A
  • Need more succinylcholine

- Very sensitive to non-depolarizers

110
Q

Signs/symptoms of MH

A
  • Muscle rigidity
  • Increased ETCO2
  • Tachycardia
  • Fever
  • Myoglobinemia
  • Increase creatinine
111
Q

Patients with pseudocholinesterase deficiency may be sensitive to what drug

A

Succinylcholine

112
Q

What is TSH

A

Hormone that stimulates the thyroid gland to secrete T4 and T3

113
Q

What hormone stimulates the production of TSH

114
Q

What hormone inhibits the production of TSH

A

Somatostatin

115
Q

Signs of hyperthyroidism

A
  • Goiter
  • Exophthalmos
  • Anxiety
  • Tachycardia
  • Increased sweating
  • Hyperkinesia
  • Fatigue
116
Q

Grave’s disease is associated with what endocrine abnormality

A

Hyperthyroidism

117
Q

How are labs changed with hyperthyroidism

A
  • Increased T3/T4
  • Decreased TSH
  • Increased Ca2+
118
Q

S/s of hypothyroidism

A
  • Weight gain
  • Bradycardia
  • Cold intolerance
  • Anorexia
  • Cardiac rub
  • Etc.
119
Q

How are labs changed with hypothyroidism

A
  • Low T4
  • Increased TSH
  • Hyponatremia
  • Hypoglycemia
120
Q

Most common complications seen with hypothyroidism

A

Cardiac complications such as CAD and CHF

121
Q

What is a complication of SEVERE hypothyroidism that is most often seen in elderly women?

A

Myxedema coma - hypothermia, hypoventilation, hyponatremia, hypoxia, hypotension

122
Q

Treatment for hypothyroidism

A

Synthetic levothyroxine (Synthroid)

123
Q

Parathyroid hormone raises serum levels of which electrolyte?

124
Q

Most common cause of hyperparathyroidism

A

Parathyroid adenoma

125
Q

2 signs of hypocalcemia that can be tested in pre-op

A
  • Trousseau’s sign

- Chvostek’s sign

126
Q

What Chvostek’s sign

A

Abnormal contraction to stimulation of the facial nerve

127
Q

What is Trousseau’s sign

A

Spasm in hand muscles when the brachial artery is occluded

128
Q

Most common endocrine disease

A

Diabetes mellitus

129
Q

Type I DM

A

Autoimmune disorder in which the body produces no insulin

130
Q

Type II DM

A

Deficiency or resistance to insulin

131
Q

What is Addison’s disease

A

Adrenal insufficiency disorder that occurs when adrenal glands don’t produce enough cortisol or aldosterone

132
Q

Symptoms of Addison’s disease

A
  • Fatigue
  • Weakness
  • Appetite loss
  • Hypotension
  • Darkening of skin
133
Q

How is Addison’s disease diagnosed

A

ACTH stimulation test - patient’s with Addison’s disease do not respond to ACTH

134
Q

What is Cushing’s disease

A

Adrenal disease caused by exposure to excessive cortisol levels usually due to ACTH secreting pituitary adenoma

135
Q

Symptoms of Cushing’s disease

A
  • Weight gain in face and on back
  • Excess hair growth (hirsutism)
  • Hypertension
  • Weakness/fatigue
136
Q

Diagnosis of Cushing’s disease

A
  • Dexamethasone suppression test

- 24 hour urine for cortisol

137
Q

What are pheochromocytomas

A

Rare catecholamine secreting adrenal tumor

138
Q

Diagnosis for pheochromocytomas

A
  • Plasma metanephrine

- 24 hour urine for catecholamines

139
Q

Preop drug regimen before pheochromocytoma removal

A

Alpha blockage with phenoxybenzamine 7-10 days preop following by beta blocker

140
Q

What preop test should be given to any female of childbearing age (12-50)

A

Pregnancy test

141
Q

What hormone is detected by pregnancy tests

142
Q

Most common indications for pregnant women undergoing non-obstetric surgery

A
  • Acute appendicitis

- Cholecystitis

143
Q

Anesthetic risks of a pregnant patient

A
  • Hypoxia (decreased FRC)
  • Difficult intubation (swelling)
  • Hypotension (aortocaval compression)
  • Aspiration
144
Q

A fetus is considered viable at…

145
Q

Potential concerns assc. with aloe

A

Hypokalemia due to diarrhea

146
Q

Potential concerns assc. with Echinacea

A

Immunostimulant that inhibits CYP3A4 so causes a risk of toxicity for drugs metabolized by CYP3A4 (alprazolam, CCBs, protease inhibitors)

147
Q

What is caused from toxicity of Echinacea

A

Hepatic inflammation

148
Q

Potential concerns assc. with garlic

A
  • Inhibits platelet aggregation

- Induces CYP450 (decreases effectiveness of drugs metabolized by it)

149
Q

Symptoms of garlic toxicity

A
  • GI discomfort

- Hemorrhage

150
Q

Drug interactions with garlic

A

Increases INR with warfarin

151
Q

How long before surgery should garlic supplement be stopped

152
Q

Potential concerns assc. with ginkgo biloba

A

Inhibits platelet-activating factor

153
Q

Drug interactions with ginkgo biloba

A
  • Warfarin

- MAOIs

154
Q

Symptoms of ginkgo biloba toxicity

A
  • GI discomfort
  • Dizziness
  • Seizures
  • Bleeding
155
Q

Potential concerns assc. with ginseng

A
  • HTN
  • Tachycardia
  • Bleeding
  • CNS stimulation
  • Hypoglycemia
156
Q

Symptoms of ginseng toxicity

A
  • HTN

- Tachycardia

157
Q

Drug interactions with ginseng

A
  • Decreased INR with warfarin
  • Increases hypoglycemic effects of insulin
  • Increases manic like episodes with MAOIs
158
Q

Potential concerns assc. with saw palmetto

A
  • Intraop bleeding
  • N/V
  • Diarrhea
159
Q

Drug interactions with saw palmetto

A

Anticoagulants

160
Q

Potential concerns assc. with St. John’s wort

A
  • Works as a possible weak MAOI or SSRI

- Risk of serotonin syndrome

161
Q

Drug interactions with St. John’s wort that we use in the OR

A
  • Opioids
  • Sympathomimetics (exaggerated response)
  • Benzos
162
Q

Drug interactions with St. John’s wort that patients take at home

A
  • CCBs
  • Warfarin
  • Digoxin (won’t work)
  • Oral contraceptives
163
Q

Potential concerns assc. with Coenzyme Q10

A
  • Decreased effectiveness of warfarin (decreased INR)
  • Hypoglycemia
  • Decreased statins
164
Q

Potential concerns assc. with dong quai

A

Inhibition of platelet aggregation

165
Q

Drug interactions with dong quai

A
  • Increased INR

- Estrogen-like effects with hormone meds

166
Q

Potential concerns assc. with vitamin E

A

Bleeding possible with higher doses

167
Q

When should most dietary supplements be stopped prior to surgery

168
Q

When should ginkgo be stopped prior to surgery

169
Q

When should ginseng be stopped prior to surgery

170
Q

When should St. Johns wort be stopped prior to surgery

171
Q

Herbal supplement with laxative properties and a risk of hypokalemia

172
Q

Herbal supplement that can increase manic like episodes with MAOIs

173
Q

OR drugs that interact with St. Johns wort

A
  • Opioids
  • Sympathomimetics
  • Benzos
174
Q

Dietary supplements that do not influence bleeding

A
  • Aloe
  • Echinacea
  • St Johns wort
175
Q

Uses for Echinacea

A
  • URIs

- Flu

176
Q

Uses for garlic

A
  • HTN
  • HLD
  • Infection
  • Cancer
  • Atherosclerosis
177
Q

Uses for ginkgo biloba

A
  • Circulatory disorders like Raynaud’s
  • Increased mental acuity
  • Tinnitus
  • Vertigo
  • Sexual dysfunction
178
Q

Uses for Ginseng

A
  • Immunostimulation
  • Diabetes mellitus
  • Menopause
179
Q

Uses for Saw palmetto

A
  • BPH
  • Pelvic pain
  • Bladder disorders
180
Q

Uses for St Johns wort

A
  • Depression
  • Anxiety
  • Sleep
181
Q

Uses for Coenzyme Q10

A
  • CHF
  • CAD
  • HTN
  • HLD
  • DM
182
Q

Uses for dong quai

A
  • Menopausal symptoms

- GYN issues

183
Q

Uses for vitamin E

A
  • Antioxidant
  • Antiaging
  • Heart health
  • Cancer
  • Fibrocystic breast syndrome
184
Q

Intrinsic rate of SA node

185
Q

Intrinsic rate of atrial foci

186
Q

Intrinsic rate of AV node

187
Q

Intrinsic rate of ventricular foci (HIS bundle, bundle brances, purkinje fibers)

188
Q

Voltage of 1 small square on EKG paper

189
Q

Anterior EKG leads

190
Q

Lateral EKG leads

A

I, aVL, V5, V6

191
Q

Inferior EKG leads

A

II, III, aVF

192
Q

What does a wide QRS complex tell you

A

Beat most likely originates in ventricles

193
Q

2 leads that we use to determine normal axis

194
Q

Portion of the EKG that we use to look for atrial enlargement

195
Q

What on an EKG indicates ventricular hypertrophy

A

Increased voltage of QRS complexes

196
Q

Normal PR interval

A

Less than 0.2 seconds

197
Q

Normal QRS interval

A

0.08-0.1 seconds

198
Q

What factors is the length of the QT interval based on

A

Sex and heart rate

199
Q

What is sinus arrhythmia

A

When the SA node fires faster with inspiration

200
Q

What is the origin of ectopic beats

A

Groups of pacemaker cells throughout the conduction system of the heart that are capable of spontaneous depolarization

201
Q

What atrial dysrhythmia is characterized by a “warm up period”

A

Paroxysmal atrial tachycardia

202
Q

What dysrhythmia is characterized by at least 3 different P wave morphologies

A

Multifocal atrial tachycardia (if over 100bpm) or Wandering Atrial Pacemaker

203
Q

When is Accelerated Idioventricular Rhythm seenon the EKG?

A
  • During acute infarction

- After reperfusion of a blocked coronary artery

204
Q

What electrolyte disturbances can cause Torsades de Pointes?

A
  • Hypocalcemia
  • Hypomagnesemia
  • Hypokalemia
205
Q

EKG change seen in V2 that is indicative of right bundle branch block

A

r/R’ wave

206
Q

EKG change seen in Lead I that is indicative of RBBB

A

Slurred S wave

207
Q

EKG change seen in V1 that is indicative of left bundle branch blood

A

Widened, abnormal QRS complex

208
Q

EKG change seen in V6 that is indicative of LBBB

A

r/R’ wave with absent Q wave

209
Q

EKG changes assc. with left anterior fascicular block

A

1) Positive qR wave in lead I

2) Negative rS in leads II and III

210
Q

EKG changes assc. with left posterior fascicular block

A

1) Negative rS wave in lead I

2) Positive qR in leads II and III

211
Q

Normal cardiac QRS axis

A

-30 to 90 degrees

212
Q

Directions of Leads I and aVF in a normal cardiac axis

A

Both positive

213
Q

Directions of Lead I and aVF in left axis deviation

A

Lead I positive, aVF negative

214
Q

Directions of Lead I and aVF in right axis deviation

A

Lead 1 negative, Lead aVF positive

215
Q

2 leads used to determine atrial enlargement

A
  • Lead II

- V1

216
Q

Peaked P waves in inferior leads is indicative of…

A

P pulmonale

217
Q

Cause of P pulmonale

A

Pulmonary HTN

218
Q

Notched P waves in Lead II and V1 is indicative of…

219
Q

Causes of P mitrale

A
  • HTN
  • A fib
  • Mitral stenosis
220
Q

How do you diagnose LVH on an EKG?

A

The sum of the S wave in V1 or V2 and the R wave in V5 or V6 is greater than 35mm

221
Q

How do you diagnose RVH on an EKG?

A

RAD with QRS axis exceeding 100 degrees. R wave is larger than the S wave in V1 and S wave is larger than R wave in V6

222
Q

ST changes assc. with myocardial INJURY

A

ST elevation

223
Q

ST changes assc. with myocardial ISCHEMIA

A

ST depression

224
Q

Stages of an acute MI

A

1) Peaked T waves
2) ST elevation
3) Q waves
4) T wave inversion

225
Q

What EKG change IS diagnostic of an MI?

A

Appearance of pathological Q waves

226
Q

What coronary artery supplies the anterior portion of the heart and the septum?

A

Left anterior descending

227
Q

What coronary artery supplies the lateral wall of the left ventricle?

A

Left circumflex

228
Q

What coronary artery supplies the inferior portion of the heart?

A

Right coronary

229
Q

What EKG change can be seen with hypokalemia

230
Q

“Digitalis effect” on an EKG

A

Downsloping of ST segment

231
Q

S1Q3T3 is associated with

A

Pulmonary embolus

232
Q

EKG change assc. with pericarditis

A

Diffuse ST elevation

233
Q

EKG change assc. with intracranial hemorrhage

A

Deep T wave inversion

234
Q

EKG change assc. with hypercalcemia

A

Shortened QT segment

235
Q

Definition of ASA 4 classification

A

A patient with severe systemic disease that is a constant threat to life

236
Q

Lab values for hyperthyroidism

A
  • Elevated T3/T4
  • Decreased TSH
  • Hypercalcemia
237
Q

Posterior pituitary hormones

A
  • ADH

- Oxytocin

238
Q

Incidence of unrecognized pregnancy

239
Q

Major risk factors assc. with diabetes mellitus

A
  • Heart disease
  • Stroke
  • Kidney disease
  • Blindness
  • Nontraumatic amputations
240
Q

What is listed as #1 under the problem list on the anesthesia consult

A

Reason for surgery

241
Q

What is the most serious effect of untreated OSA

A

Heart problems

Clinical Methods (4 decks)

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