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APA/Foundations 2 > Final Review - 1st 1/2 of semester > Flashcards

Final Review - 1st 1/2 of semester Flashcards

1
Q

Compression of fibular head on leg brace causes damage to which nerve?

A

Common perineal

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2
Q

Compression of medial tibial condyle causes damage to which nerve?

A

Saphenous

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3
Q

Excessive external rotation of legs and excessive extension of the knees causes damage to which nerve?

A

Sciatic

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4
Q

Excessive flexion of the going from the surgeon leaning on the inside of the leg causes damage to which nerve?

A

Obturator and femoral

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5
Q

Levels of regional anesthesia for cystoscopy

A

T9-10 sensory level or T8 for ureters

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6
Q

Risks of bladder perf specific to general and regional anesthesia for a TURBT

A

General - coughing or straining –> bladder perf

Regional - bladder atonic –> thinner when distended –> increased risk of perf

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7
Q

S/S bladder perf in awake pt

A
  • shoulder discomfort
  • N/V
  • suprapubic fullness
  • abd spasm
  • pain
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8
Q

S/S bladder perf in anesthetized pt

A

HTN and tachycardia followed by severe HoTN

also DIC

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9
Q

Early signs of venous absorption of irrigation fluid during TURP

A

HTN and tachycardia, dyspnea, SOB

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10
Q

Late signs of TURP syndrome

A

apprehension, disorientation, convulsions, coma

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11
Q

Disadvantages to the following irrigation solutions:
Glycine
Sorbitol
Mannitol

A

Glycine - blindness
Sorbitol - hyperglycemia and lactic acidosis
Mannitol - hypervolemia, osmotic diuresis

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12
Q

TURP syndrome tx

A

Fluid restriction and diuretics (give hypertonic solutions cautiously)

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13
Q

Anesthesia considerations with Methylene blue 1% dye and indigo carmine dye

A

Methylene blue - can cause Hotn

Indigo - HTN Alpha sympathomimetic

Both - O2 sat appears to be low when it is actually ok (methylene greater effect than indigo)

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14
Q

Problem w kidney bar during nephrectomy

A

can cause vena cava compression and HoTN

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15
Q

What should be given for angioedema during anaphylactoid reaction?

A

FFP, then give it 20-30 min to work. you may not need to intubate. Decadron won’t work.

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16
Q

S/S hemolytic transfusion reaction in anesthetized pt

A 
CV instability
HoTN
Fever
hemoglobinuria
bleeding diathesis
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17
Q

A pt with HIV is on NNRTIs. What is the anesthesia team concerned about?

A

NNRTIs induce the CYP450 system

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18
Q

Most common opportunistic pathogen in HIV

A

Pneumocystic carinii

PNA responsible for most deaths

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19
Q

Risk for percutaneous exposure to HIV

A

0.3%

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20
Q

Most common cause of death in SLE pt

A

Renal failure

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21
Q

3 anesthesia considerations in SLE pts

A
  1. cricoarytenoid arthritis (difficult intubation)
  2. RLN pasty
  3. Cyclophosphamide (immunosuppressant) inhibits plasma cholinesterase –> ester LA and Succs last longer (RA pts also take this drug)
22
Q

Absolute contraindications to central line placement

A

Refusal
Infection at site
Anatomic obstruction
Superior vena cava syndrome

23
Q

Relative contraindications to central line placement

A

Coagulopathy
Systemic infection
Pacing wires or indwelling catheters present at insertion site
RVAD

24
Q

How long to prep with CHG before central line insertion

A

30 sec, let it dry for 2 min

25
Q

Where is the IJ located

A

B/t the sternal and clavicular heads of the sternocleidomastoid muscle - insert the needle at the apex of the triangle

Lateral to carotid artery

26
Q

major risk factors in the development of PVD

A

Smoking and DM

27
Q

Single most significant risk factor influencing long-term survivability after abd aortic reconstruction.

A

CAD

28
Q

Most reliable definition of coronary anatomy and extent of CAD

A

Coronary angiography

29
Q

Thought to be the primary cause of AAA in 90% of pts

A

atherosclerosis

30
Q

Surgical intervention is recommended for aneurysms greater than ____ cm in diameter

A

5.5 (another place says 4-5 cm)

31
Q

Most common type of endoleak

A

Type II - collateral retrograde perfusion; spontaneously closes w/i the first mo of implantation

32
Q

What poses the greatest risk of mortality after an open AAA reconstruction?

A

Myocardial ischemia

intraop: monitor lead II for detection of dysrhythmias and V5 for analysis of ischemic ST-segment changes

33
Q

Standard approach for elective AAA repair

A

Transperitoneal incision

retroperitoneal incision appears to maybe have fewer complications though

34
Q

best and most common site for AoX in open AAA repair

A

infrarenal (most aneurysms develop below the level of the renal arteries)

35
Q

T/F: AoX causes HTN above the cross clamp and HoTN below the cross clamp.

A

True (increase in MAP and SVR above clamp, but CO decreases or remains unchanged. Nitro is the drug of choice for tx of HTN during AoX)

36
Q

T/F: The incidence of neurologic complications increases as the clamp is positioned higher on the aorta

A

True

Artery of Adamkiewicz is somewhere b/t T9-T12

37
Q

How to prepare for AoX release

A

FLUID LOAD THE PT - increase CVP 3-5 mmHg or PAOP 3-4 mmHg

Increase minute ventilation and maybe NaHCO3 to tx acidosis

Vasopressors ready to go

38
Q

What should UOP be during AAA repair?

A

1 mL/kg/hr

39
Q

What contributes more frequently to poor surgical outcomes of CEA, MI or stroke?

A

MI

Dipyridamole-thallium imaging is very suggestive of increased risk of adverse cardiac events

40
Q

Vasoconstrictors released by the endothelial cells

A

Thromboxane A2 and Adenosine diphosphate (ADP)

41
Q

Vasodilators released by endothelial cells

A

NO and Prostacyclin

42
Q

What causes the plt to undergo a conformational change and become “activated”?

A

Tissue Factor

43
Q

What is the role of GP Ib?

How about GP IIb and IIIa?

A

GP Ib - attaches pots to vWF and attracts additional plts to the endothelial lining

GP IIb-IIIa complex links plts together to form a primary plt plug

44
Q

With the exception of Factor V and Factor VIII, all cofactors are ________

A

enzymes

Thye circulate in their inactive state until they are activated to assist in coagulation

45
Q

Which coag factors aren’t synthesized in the liver? Where are they synthesized?

A

Factor III - Tissue Factor - Vasc wall/extravasc cell membrane

Factor IV - Calcium - Diet

vWF - Endothelial cells

46
Q

Which factors are vitamin K dependent?

A

II - Prothrombin
VII - Stable factor
IX - Christmas factor
X - Stuart Prower Factor

47
Q

Antithrombin III interferes w coagulation by binding to and removing which clotting factors from the clotting cascade?

A

XII, XI, X, and IX which influences II

48
Q

Proteins C and S inhibit clot formation by inhibiting which factors?

A

III, V, and VIII

49
Q

Which clotting component works both on the procoagulant and fibrinolytic systems?

A

Thrombin

Procoagulant: Activates Factors V, VIII, I, and XIII, recruits plts to injured area, and must be present in adq amts to activate sufficient fibrin to form a stable (secondary) clot

Fibrinolytic: Releases tPA from endothelial cells, stimulates proteins C and S, ?Antithrombin III

50
Q

Plasminogen is activated into plasmin in the presence of ______ and ______

A

tPA, urokinase, and streptokinase

51
Q

What halts fibrinolysis when the clot is digested?

A

A-Antiplasmin and Tissue plasminogen activator inhibitor (tPA inhibitor)

52
Q

2 main functions of vWF

A
  1. facilitate plt adhesion (to the vessel wall)

2. behave as a plasma carrier for factor VIII

APA/Foundations 2 (6 decks)

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