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Basics of Anesthesia > Final Exam > Flashcards

Final Exam Flashcards

1
Q

What conditions cause R ventricular hypertrophy?

A

COPD, pulmonary stenosis, tricuspid insufficiency, posterior MI

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2
Q

What EKG findings will you see with R ventricular hypertrophy?

A

Tall R wave in V1, progressive decrease in amplitude in V4, shifting QRS vector to right with increased R precordial waves

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3
Q

What are some causes of secondary T wave abnormalities?

A

conduction disturbances, ventricular hypertrophy, CNS ischemia

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4
Q

What EKG findings would you see with left ventricular hypertrophy?

A

deeper right precordial S waves and taller left precordial R waves

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5
Q

How do you calculate MAP?

A

(SBP + 2 DBP)/3

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6
Q

For every 10 cm change, the BP changes by

A

7.4 mm Hg

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7
Q

For every inch change, the BP changes by

A

2 mmHg

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8
Q

What is the calculation for allowable blood loss?

A

ABL = EBV x [(starting Hct-target Hct)/starting Hct]

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9
Q

What should your Hct be in relation to your Hgb?

A

3x

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10
Q

How do you calculate EBV?

A

premies: 90-100 ml/kg, full term neonates: 80-90 mL/kg, infants 80 ml/kg, adults 70 ml/kg

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11
Q

When should you transfuse?

A

healthy patients 7-8 g/dl and Hct of 21-24%; elderly or CV/pulmonary dz Hgb 10 d/dL or Hct 30%

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12
Q

How much does one unit of pRBCs raise Hgb and Hct?

A

1 and 2-3%

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13
Q

What is the ideal BP cuff size?

A

ideal length 80% of extremity circumference, 40% of extremity circumference

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14
Q

Deflation of the IABP should occur at what point?

A

Before QRS complex

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15
Q

How do you calculate maintenance fluid rate?

A

4,2,1 rule (or if over 20 kg, just take weight and add 40)

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16
Q

How do you calculate TBW deficit?

A

(0.6 x kg) x ](Na-140)/140]

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17
Q

What are some causes of decreased SvO2?

A

hyperthermia, shivering, seizures, reduced pulmonary transport of O2, hemorrhage, decreased CO

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18
Q

What are some causes of increased SVO2?

A

hyperdynamic conditions, sepsis, L-R shunts, cyanide poisoning increased CO, unintentional PA wedge, L shift in O2Hgb curve

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19
Q

What does hyperkalemia do to your EKG?

A

narrow peaked T wave, arrhythmia, wide QRS, heart block

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20
Q

How do you calculate NPO status replacement?

A

hrs NPO x maintenance rate

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21
Q

What is considered a minimally invasive procedure and what is the fluid requirements?

A

lower abdomen, hernia repair, small plastics - 2 ml/kg

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22
Q

What is considered a moderately invasive procedure and what is the fluid requirements?

A

upper abdomen, appy, chole, uncomplicated ortho procedures- 4 ml/kg

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23
Q

What is considered a severely invasive procedure and what is the fluid requirements?

A

upper and lower abdomen, total hip, bowel resection- 8 ml/kg

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24
Q

What is the fluid replacement in the first hour of surgery?

A

1/2 NPO deficit + 3rd space loss + maintenance

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25
Q

What is the fluid replacement in the 2nd and 3rd hours of surgery, each?

A

1/4 NPO deficit + 3rd space loss + maintenance

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26
Q

What is the fluid replacement in the 4th hour of surgery and beyond?

A

3rd space loss + maintenance

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27
Q

What EKG changes will you see with hypercalcemia?

A

shortened ST and QT interval

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28
Q

What are the goals of ERAS?

A

decrease LOS and morbidity, faster recovery, decreased readmission rates, decreased cost

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29
Q

What are pre-op considerations for ERAS?

A

optimize pre-op conditions, educate pt and family to set realistic expectations, and emphasize fasting period

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30
Q

What are the fasting guidelines for ERAS?

A

2 hours for clear liquids, 2 glasses of water before bed and morning of, carb rich drink 2 hours prior

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31
Q

What are common premedications for ERAS?

A

acetaminophen, celecoxib, gabapentin, heparin

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32
Q

What medications should you avoid giving routinely preop according to ERAS?

A

benzos

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33
Q

What does ERAS recommend for induction?

A

propofol, intermediate acting NMBA (roc) or succs, antibiotic prophylaxis 30-60 min before incision

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34
Q

What are mechanical ventilation optimal parameters for ERAS?

A

tidal volume 6-8 ml/kg IBW, PEEP 5 (10 for lap procedures), FiO2 50%, 8 RR to maintain ETCO2 40

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35
Q

Describe TRALI

A

Transfusion related lung injury- caused by transfusion of antibodies that interact with pt’s WBCs- aggregate in pulmonary circulation and damages alveolar capillary membrane

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36
Q

What is TACO?

A

transfusion associated circulatory overload

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37
Q

What’s the difference between type, screen, and crossmatch?

A

type- 5 minutes, tests for ABO and Rh antigens; screen- 45 minutes, tests for antibodies; crossmatch- 45 min, tests compatibility between recipient serum and actual blood to be transfused

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38
Q

What should you do for an emergency transfusion?

A

2 pRBCs of uncrossmatched O- blood and continue until anti a/b titers are determined

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39
Q

What are PAC indicated for?

A

impaired cardiac function (CAD, valvular dysfunction, HF), evaluation of response to fluids/drugs (shock/sepsis, renal failure, severe burns, cont iontropic support), cross clamping of thoracic aorta, suspected or diagnosed pulmonary emboli, pulmonary disease (acute resp failure, COPD, pulmonary HTN)

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40
Q

What procedures are PAC indicated for?

A

CABG, valve replacement, pericardectomy, aortic surgery requiring cross clamping, sitting crani, portal systemic shunts, major pulm procedures, high risk OB

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41
Q

What are contraindications to PAC?

A

absolute- tricuspid or pulmonic valve stenosis, RA or RV masses, tetralogy of Fallot
relative- severe dysrhythmias, coagulopathies, new pacemaker or LBBB

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42
Q

How do PAC monitor CO?

A

based on Fick principle- measures concentration difference in fluid stream over time using thermodilution technique

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43
Q

Describe thermodilution technique

A

injection of known quantity and temp bloused through proximal port of PAC at end expiration- average of 3 injections used

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44
Q

CO value is derived from the ? (thermodilution technique)

A

total area under the waveform

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45
Q

What is CVP?

A

measures fluid pressure entering R side of heart

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46
Q

What is the a wave on CVP and where is it on EKG?

A

RA contraction; just after P wave

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47
Q

What is the c wave on CVP and where is it on EKG?

A

ventricular contraction, tricuspid closing and bulging; just after QRS

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48
Q

What is the v wave on CVP and where is it on EKG?

A

atrial filling; just after T wave begins

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49
Q

What is the x descent on CVP and where is it on EKG?

A

atrial relaxation/ventricular systole; ST segment

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50
Q

What is the y descent on CVP and where is it on EKG?

A

tricuspid opens and blood fills ventricle; after T wave ends

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51
Q

What is the risk when using L IJ approach?

A

thoracic duct damage

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52
Q

What is the distance from the L IJ insertion site to vena cava- RA junction?

A

20 cm

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53
Q

Where should the PAC tip be?

A

zone 3- uninterrupted blood flow

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54
Q

What are s/s of hypermagnesemia?

A

lethargy and loss of DTRs, decreased BP/HR, decreased RR, increased PR interval, wide QRS, prolonged QT

55
Q

What are causes of hypernatremia?

A

loss of water in excess to Na or retention of large quantities of Na- osmotic diuresis, diarrhea, perspiration, DI, nephrogenic diabetes, hypertonic saline, hyperaldosteronism/Cushing’s

56
Q

What is a significant electrolyte imbalance that can occur from massive transfusion?

A

hypocalcemia- Ca binding by citrate preservative

57
Q

What is an acid/base imbalance from massive transfusion?

A

metabolic alkalosis (citrate and lactate are converted to bicarb by the liver)

58
Q

What is hetastarch and what can it cause?

A

colloid; coagulopathy

59
Q

What is the distance from PAC insertion to RA, and what does the waveform look like?

A

20-30 cm, small amplitude waveform

60
Q

What is the distance from PAC insertion to RV, and what does the waveform look like?

A

30-40 cm, high amplitude waveform

61
Q

What is the distance from PAC insertion to PA, and what does the waveform look like?

A

40-50 cm, high amplitude waveform with higher diastolic trough than RV

62
Q

What is the distance from PAC insertion to PCW, and what does the waveform look like?

A

45-55 cm; similar waveform to RA but higher pressure

63
Q

What are the 4 variables of mixed venous oximetry? (What is the equation?)

A

SvO2 = SaO2 - [VO2/(Q x 1.34 x Hgb x 10)]

64
Q

What is the purpose of PACU?

A

critical assessment, stabilization, prevention and detection of complications

65
Q

What are the benefits of MAC?

A

Quicker recovery in OR, shorter PACU time, less N/V, less cost, high patient satisfaction

66
Q

Goals of operative positioning

A

optimum surgical exposure, access for monitoring, prevent complications and injuries, maintain body integrity and physiological function

67
Q

Describe brachial plexus nerve injury

A

prevents muscles of arm and hand from working properly, loss of feeling

68
Q

Describe ulnar nerve injury

A

numbness/tingling of 4th and 5th fingers

69
Q

Describe radial nerve injury

A

drooping of wrist and fingers

70
Q

Describe suprascapular nerve injury

A

pain in shoulder, weakness and loss of shoulder function

71
Q

Describe sciatic nerve injury

A

weakness of knee flexion, foot movements, difficulty bending food inward and down

72
Q

Describe common peroneal nerve injury

A

inability to dorsiflex toes

73
Q

Describe posterior tibial nerve injury

A

flattening of foot, inward rolling of ankle, turning out of toes and foot

74
Q

Describe saphenous nerve injury

A

loss of sensation over medial aspect of lower leg

75
Q

Describe obturator nerve injury

A

difficulty with ambulation, unstable leg

76
Q

Describe pudendal nerve injury

A

phantom pain of lower regions of pelvis

77
Q

Describe femoral nerve injury

A

affects ability to walk, problems with sensation of leg and food

78
Q

What are common nerve injuries in lithotomy?

A

common peroneal, femoral nerve

79
Q

What surgical position can cause compartment syndrome from occlusion of the femoral artery?

A

lithotomy

80
Q

What are some useful pieces of information from previous anesthesia record?

A

induction drugs/doses used, tube size used, history of MH, pseudocholinesterase deficiency

81
Q

What is the purpose of Murphy eye, and should your stylet pass it?

A

allows for release of pressure; no

82
Q

How do you perform a Mallampati?

A

sit upright, extend neck, open mouth wide, stick out tongue, do NOT phonate

83
Q

What are the components of the preop assessment?

A

name, DOB, verify procedure, indication for procedure, med history, prior anesthetic history, H&P (airway), lab results, consults, pt eduation, informed consent

84
Q

What changes flow from laminar to turbulent?

A

change in direction >20 degrees, increased velocity, corrugated tubing

85
Q

What are required components of vaporizers?

A

concentration calibrated, interlock system, liquid level present, keyed filler device, no discharge of liquid anesthetic

86
Q

Describe variable bypass vaporizer

A

splits gas into vaporizer above and through liquid agent- uses bimetallic strip

87
Q

Describe electronic vaporizer

A

computer calculates volume of gas to get concentration- heated and pressurized

88
Q

Which way do the vaporizer knobs move?

A

counter clockwise

89
Q

What is the Tec 6 heated and pressurized at?

A

39 C and 2 atm

90
Q

All the muscles that move the VC (abductors, adductors, tensors) are supplied by the ? except the cricothyroid muscle, which is supplied by the ?

A

RLN; SLN

91
Q

For sensory, above the VC, the larynx is supplied by the ? and below the VC by the ?

A

ILN (branch of SLN); RLN

92
Q

What does the internal branch of SLN do?

A

sensory input above VC

93
Q

What does the external branch of SLN do?

A

motor to cricothyroid muscle

94
Q

Where is the R RLN?

A

branches from vagus, loops around brachiocephalic artery

95
Q

Where is the L RLN

A

branches from vagus and recurs around aorta

96
Q

What is the only motor branch of the glossopharyngeal nerve?

A

stylopharyngeus

97
Q

What do the posterior cricoarytenoids do?

A

abducts cords

98
Q

What do the lateral cricoarytenoids do?

A

adducts cords

99
Q

What muscles close the glottis?

A

aryepiglottic and oblique arytenoid muscles

100
Q

What muscles open the glottis?

A

thyroepiglottic muscles

101
Q

What is the ideal gas law?

A

PV=nRT or PV=T

102
Q

Boyles law

A

T constant, P and V inversely proportional

103
Q

Charles law

A

P constant, T and V directly proportional

104
Q

Gay Lussac law

A

V constant, T and P directly proportional

105
Q

How do you calculate the contents of an O2 cylinder?

A

2000 psi/660 L, cross multiply with current pressure

106
Q

when should you change your O2 cylinder?

A

1000 psi or less

107
Q

What is Fick’s law?

A

diffusion is directly proportional to surface area and gradient and inversely proportional to membrane thickness

108
Q

How do you calculate TV delivered if your machine does NOT decouple and does NOT account for compliance?

A

(TV+FGF)-compliance

FGF- TV in mL divided by I:E ratio divided by RR
compliance- compliance x PIP

109
Q

How do you calculate FiO2?

A

divide actual oxygen by total amount of liters

ex) 1 L of O2 and 1 L of air- 1.21/2= about 60%

110
Q

What is the purpose of a diaphragm valve and where is it found on the machine?

A

reduces pressure- first and second stage regulator (decreases pressure from cylinder)

111
Q

What are some examples of active cardiac conditions?

A

unstable coronary syndromes (unstable angina, severe angina, recent MI), decompensated HF, significant arrhythmias (high grade AV block- mobitz 2 and 3rd degree, SVT or Afib RVR, symptomatic ventricular arrhythmias or bradycardia, new onset VT), severe valvular disease (AS, MS)

112
Q

EKG findings with posterior MI

A

R wave >0.04 seconds in V1 and V2 and R/S >1 posterior, depressed ST

113
Q

What artery is affected in posterior MI?

A

posterior descending

114
Q

What EKG findings would you see in RBBB?

A

V1- rSR (triphasic, wide QRS, inverted T

V6- small q wave, broad S wave, upright T

115
Q

What EKG findings would you see in LBBB?

A

V1- broad negative QRS

V6- positive QRS, broad R wave, no Q wave or S wave

116
Q

EKG changes with inferior wall infarct

A

ST elevation in II, III, aVF; ST depressions in I and aVL; abnormal Q waves in II, III, aVF

117
Q

What are re-entry or circus movements?

A

re-excitation of cardiac tissue from same cardiac impulse- mechanism of most tachydysrhythmias

118
Q

What are requirements of re-entry/circus movements?

A

imbalance between conduction and refractoriness, unidirectional block

119
Q

What are some causes of re-entry/circus movements?

A

elongation of conduction pathway (chamber enlargement), decreased velocity of conduction of cardiac impulse (after MI), shortened refractory period (toxic doses of antidysrhythmics)

120
Q

What lead is best for detecting ischemia?

A

V5

121
Q

The ? represents the combination of all the instantaneous vectors during ? into a single vector that we call ?

A

mean cardiac vector; systole; axis

122
Q

Limb leads determine the axis in the ? plane and provide information about the position of the electrical activity of the heart as it rotates around an ? axis. This is the axis we will deal with as it is the most commonly reported on EKGs

A

frontal; anteroposterior

123
Q

Intersection of leads ? and ? divide the precordium into 4 quadrants

A

I and aVF

124
Q

What is a normal axis?

A

0 to 90 between positive poles of leads I and aVF- QRS is upright in both

125
Q

What is R axis deviation?

A

90 to 180- QRS is negative in I and positive in aVF

126
Q

What is L axis deviation?

A

0 to -90- QRS is positive in I and negative in aVF

127
Q

What is indeterminate axis deviation?

A

-90 to -180 QRS is negative in both leads

128
Q

What leads monitor the lateral wall of the LV?

A

V5-6

129
Q

What leads monitor the anterior LAD?

A

V1-V6

130
Q

In lead I, left arm is ? and right arm is ?

A

positive; negative

131
Q

In lead II, right arm is ? and foot is ?

A

negative; positive

132
Q

In lead III, left arm is ? and foot is ?

A

negative; positive

133
Q

Name the 9 cartilages of the larynx

A

single- cricoid, thyroid, epiglottic

paired- arytenoid, corniculate, cuneiform

Basics of Anesthesia (8 decks)

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