Final Cram

Question 1

The vomiting center lies in the ______ and consists of the nucleus of the ______ & parts of reticular formation

Answer 1

Medulla oblongata; tractus solitarius

Question 2

Detects noxious chemicals in the bloodstream

Answer 2

CRTZ

Question 3

Upon activation, the vomiting center sends _______ via the CN _____ through the ________ & _______ and to skeletal muscle through ________. Signals for t eh vomiting center via these nerves trigger the motor process resulting in emesis

Answer 3

Efferent signals; V, VII, IX, X, XII; vagal parasympathetic fibers; sympathetic chain; alpha motor neurons

Question 4

Pt PONV risk factors

Answer 4

Women, non smokers, hx of motion sickness, previous PONV

Question 5

Surgical risk factors for PONV

Answer 5

LOSx, laparotomies, gynecological procedures, ENT, breast, plastic, ortho

Question 6

10-20mg IV over 3-5 min 15-30 min before induction results in increased LES tone & decreased gastric fluid volume

Answer 6

Reglan

Question 7

Reglan should not be administered to which pts?

Answer 7

Parkinson’s, restless leg, or movement disorders r/t dopamine inhibition/depletion

Question 8

Droperidol prophylactic dose for PONV

Answer 8

0.625 - 1.25 mg IV

Question 9

Nutritional support for severe burns

Answer 9

Energy requirements may double & protein triple

Question 10

___ comes from diet and ___ is synthesized by UV lights action on 7-dehydrocholesterol

Answer 10

D2, D3

Question 11

Prototype of sulfonamides that bind to carbonic anhydrase, produce non competitive inhibition of enzyme activity

Answer 11

Acetazolamide

Question 12

Where does acetazolamide inhibit carbonic anhydrase

Answer 12

Proximal renal tubules & collecting ducts

Question 13

The increase in ____ results in alkaline urine and metabolic acidosis

Answer 13

HCO3

Question 14

The increase in delivery of ___ to distal tubules leads to ___ loss

Answer 14

Na; K

Question 15

Loop diuretics inhibit reabsorption of ?

Answer 15

Na, K, Cl

Question 16

______ may be used to mobilize edema a/w renal, hepatic, or cardiac dysfuntion

Answer 16

Thiazide diuretics

Question 17

______ diuretics are ineffective in pts with severe renal insufficiency & the use of _____ diuretics is recommended for diuresis

Answer 17

Thiazide; loop

Question 18

Thiazide diuretics potentiate NMBD by producing _____

Answer 18

Hypokalemia

Question 19

Principal site of action of osmotic diuretics

Answer 19

Proximal renal tubules & loop of Henle

Question 20

Mannitol increases plasma osmolarity thus drawing fluid form ______ to ______ spaces

Answer 20

Intracellular, extracellular

Question 21

Intact ____ is necessary for cerebral effects of Mannitol. Why?

Answer 21

BBB. Non-intact BBB may enter brain drawing fluid with it causing worsening cerebral edema

Question 22

Prevent Na reabsorption in the cortical collecting duct by blocking the epithelial Na channels

Answer 22

Pteridines (K sparing diuretic)

Question 23

Prevent the synthesis and activation of the aldosterone-dependent basal cell Na-K-ATPase pump

Answer 23

Aldosterone receptor blockers (K sparing diuretic)

Question 24

Although triamterene is a weak ______ antagonist, it rarely causes megalobastic anemia except in pts already at risk for ______ deficiency

Answer 24

Folic acid

Question 25

Large volumes of NS can result in ?

Answer 25

Hyperchloremic metabolic acidosis

Question 26

Contain macromolecules suspended in electrolyte solutions

Answer 26

Colloids

Question 27

Most commonly used semisynthetic colloid solution. At 26 wks trace amounts still detectable. Renal excretion is 2 phases: immediate glomerular filtration & delayed glomerular filtration

Answer 27

Hydroxyethyl Starch (HES)

Question 28

Immediate tx of life-threatening hypermagnesemia

Answer 28

Calcium gluconate 10-15 mg/kg IV, follow with diuretics or dialysis

Question 29

Tx for hypocalcemia following IV bisphosphonate:

Answer 29

Calcium & vitamin D

Question 30

Osteonecrosis of the jaw is a/w high-dose ____

Answer 30

Bisphosphonates (zoledronic acid & pamidronate)

Question 31

Which hormones influence renal K secretion:

Answer 31

Aldosterone, glucocorticoids, catecholamines, arginine vasopressin

Question 32

______ opposes and _____ favors K secretion

Answer 32

Acidosis; alkalosis

Question 33

Catecholamine shift K ______

Answer 33

Intracellularly (predominantly into liver & skeletal muscles)

Question 34

Drugs cause hyperkalemia by:

Answer 34

Redistribution; suppression of aldosterone secretion; inhibition of K secretion in distal collecting duct; direct cell destruction

Question 35

In hyperkalemia, 10-20 cc of ______ restores myocardial contractility in 1-2 min and lasts 15-20 min

Answer 35

10% calcium chloride solution

Question 36

Iatrogenic hyperglycemia can induce _____

Answer 36

Osmotic diuresis

Question 37

Primary water losses are replace with _____

Answer 37

Hypotonic solutions (maintenance type D5W, 1/2NS)

Question 38

Water & electrolyte losses are replaced with _____

Answer 38

Isotonic electrolyte solutions (replacement type NS, LR, D51/4NS)

Question 39

Crystalloids stay intravascularly for how long?

Answer 39

20-30 min

Question 40

most intraoperative fluid loss is?

Answer 40

Isotonic

Question 41

_____ solutions should be avoided in neurosurgery bc they promote cerebral edema

Answer 41

Dextrose containing

Question 42

Half-life of colloids

Answer 42

3-6 hrs

Question 43

Indications for colloids:

Answer 43

``` Fluid resuscitation (hemorrhage) prior to transfusion (trauma); Fluid resuscitation (hypoalbuminemia or protein loss) (burns) ```

Question 44

UO goal during surgery

Answer 44

0.5 - 1 ml/kg/hr

Question 45

What must be taken into consideration for fluid replacement?

Answer 45

NPO loss; Insensible loss (third space); EBL replacement; Maintenance

Question 46

Third space replacement

Answer 46

Minor trauma 2ml/kg/hr; Moderate trauma 4ml/kg/hr; Extensive trauma 8ml/kg/hr

Question 47

When does mobilization of third space fluids occur?

Answer 47

72 hrs post-op

Question 48

NPO deficit = ?

Answer 48

Hourly maintenance x hrs NPO

Question 49

Give ____+ hr maint in first hour, ____ + hr maint in second hour, & ____ + hr maint in third hour

Answer 49

1/2 NPO; 1/4 NPO; 1/4 NPO

Question 50

Acute blood loss in the range of _____ or ___% of EBV exceeds ability of crystalloids to replace w/o jeopardizing O2 carrying capacity of blood

Answer 50

1500 -2000 ml; 30%

Question 51

1 unit of PRBCs will raise Hgb ___ & Hct ___

Answer 51

1 g/dL, 3%

Question 52

10 ml/kg of PRBCs will increase Hgb ____ & Hct ___

Answer 52

3 g/dL; 10%