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AP + Phys > Foundations Final > Flashcards

Foundations Final Flashcards

1
Q

Risk of MI in the GP

A

0.3%

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2
Q

Risk of MI in previous MI patients (<1, <3, 3-6, 6>)

A

> 1- greatest risk
<3- 30%
3-6- 15%
6- 6%

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3
Q

How long to wait after MI for elective surgery?

A

4-6 weeks

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4
Q

What SYMPTOM increases the risk of MI during surgery/ anesthesia?

A

Unstable angina

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5
Q

What heart valve condition is the greatest risk for intraoperative MI?

A

Aortic stenosis (14x higher risk)

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6
Q

Goal METS score

A

0- pain at rest
4- can you walk up 2 flights of stairs? (Goal)
10- can endure athletics

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7
Q

Anesthetic considerations for OSA pateints

A

Awake extubation
Minimize opioids and versed

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8
Q

What are asthmatics at risk for?

A

Bronchospasm

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9
Q

Which pt are at high risk for aspiration?

A

SBO
GERD
DM
Hiatal hernia
Ascites
Previous gastric bypass
Obesity/ pregnancy

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10
Q

What is mendelson syndrome?

A

Chemical pneumonitis
>25 ml
<2.5 PH
Particulate aspirate > clear aspirate

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11
Q

DM rules

A

Hold oral DM meds the morning of surgery (metformin 2 days)
Take 1/4-1/2 insulin
Check BG upon arrival and intra-op

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12
Q

Signs and symptoms of pheochromocytoma

A

HTN
Diaphoresis
Tachycardia
Headache
Tremulousness (tremors)
Weight loss
HCT >45
Orthostatic HOTN

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13
Q

Cessation of smoking for how long will reduce the effects of nicotine

A

12-48 hours

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14
Q

Cessation of smoking for how long will improve PPC to normal rates

A

8 weeks

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15
Q

Drug of choice for cocaine induced HTN

A

CCBs

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16
Q

ASA classes

A

1- healthy
2- BMI 30-40
3- BMI >40
4- Surgery is constant threat to life; CVA, TIA, MI <3 months,
5- NEED surgery to survive; AAA, trauma, MODS
6- brain dead, organ donor

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17
Q

6 questions to ask in pre op

A

Name
DOB
Allergies
Surgery
Anesthesia history (and family)
Last meal

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18
Q

Most common intraop allergic reaction cause

A

Roc

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19
Q

Which meds decrease anesthesia needs?

A

Kava kava, valerian root

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20
Q

Which meds increase bleeding?

A

Ginkgo, garlic, ginseng, fish oil

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21
Q

How long to stop ASA before surgery?

A

7 days

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22
Q

How long to stop NSAIDS before surgery?

A

1-2 days

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23
Q

How long to stop plavix before surgery?

A

7 days

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24
Q

NPO guidelines

A

2h- clear liquids
4- breast milk
6- cow milk, light meal
8- greasy, fatty meal

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25
Q

What is STOP BANG

A

Assessment for OSA
Snoring
Tiredness
Observed apnea
Pressure (high blood pressure)
-
BMI >35
Age >50
Neck >40
Gender of male
0-3- low risk
4+- high risk

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26
Q

Mallampati is used to assess ___

A

Oropharyngeal space
1- pillars
2- uvula
3- soft
4-hard

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27
Q

Inter incisor gap assesses ___

A

Mouth opening and ability to align the oral, pharyngeal, and laryngeal axis
4-6 cm

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28
Q

Why would the TMD be out of range?

A

<6- Mandibular hypoplasia
>9- Larynx is caudal, tongue is caudal

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29
Q

Mandibular protrusion test assesses ___

A

TMJ funciton
1- good overbite
2- even bite
3- underbite- high risk

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30
Q

Normal AO function

A

Flexion and extension- 90-165
Extension- 35, 23 is difficult

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31
Q

Conditions that impair AO mobility

A

DM
Downs
DJD
Ankylosing spondylitis
Klippel feil
RA
Surgical fixation
Trauma

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32
Q

BONES

A

Mask
Beard
Obesity
No teeth
Elderly >55
Sleep apnea

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33
Q

LEMON

A

Look at airway (shape of face, physiology)
Evaluate 332
Mallampati
Obstruction
Neck mobility

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34
Q

SHORT

A

Surgical airway
Surgical hx
Hematoma
Obesity
Radiation
Tumor

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35
Q

RODS

A

Restricted mouth opening
Obstruction of airway
Distorted airway
Stiff lungs

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36
Q

How to chronic HTN patients react to induction?

A

A drop in BP more than normal
Maintain 20% baseline

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37
Q

What is Sellick maneuver

A

Cricoid pressure

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38
Q

Hyperthyroid rules

A

Need to be normal for 6-8 weeks, then iodine for 2 weeks
Use Beta blockers intraop to reduce T4 to T3

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39
Q

Considerations for hypothyroid

A

None!

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40
Q

What to do if patient is high off of marijuana in pre op?

A

Delay
MJ will cause tolerance to sevo

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41
Q

What to do if patient didnt take their pre op beta blocker?

A

Give BB intraoperatively

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42
Q

Why would you give reglan in pre op?

A

Reduces gastric volume

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43
Q

Why would you give robinol in pre op?

A

Reduce secretions

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44
Q

Half life of cefazolin?

A

2 hours

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45
Q

How long does it take for vitamin K to improve PT?

A

6-8 hours

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46
Q

How would you treat central anticholinergic syndrome after a dose of scopalamine?

A

Physostigmine 1-2mg IV

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47
Q

How long to wait after a CVA for surgery?

A

9 months

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48
Q

Which ASA; sever sytemic disease of at least 1 organ system that causes functional limitation

A

3

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49
Q

How do illegal drugs affect the pupils?

A

PCP- nystagmus
Cocaine- midriasis (dilation)
Fent- Miosis (constriciton)

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50
Q

How long to delay surgery after a viral respiratory infection?

A

6 weeks

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51
Q

Risk of PONV

A

Female
History of PONV
Non smoker
<50
GA (instead of RA)

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52
Q

Which sites bring the greatest risk of PPC?

A

Thoracic
Aortic
Upper abdomen

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53
Q

When do anesthesia related deaths from airway occur?

A

During emergence, not induction

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54
Q

Intraoperative awarness risk factors

A

Female
Young
Obesity
Previous awareness
Trauma/ OB/ Open heart
NDNMB

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55
Q

What is the biggest factor in anesthesia related deaths?

A

1- Human error
2- Communications

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56
Q

What percent of soda lime is water content?

A

15%

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57
Q

Sevo + baralyme =

A

Fire

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58
Q

Which tank pressure reads the same unless its empty?

A

N2O
CO2

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59
Q

The HIGH pressure leak test requires a pressure of ___

A

30 cm H2O

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60
Q

Circuit compliance equation

A

VT on ventilator - (Compliance of circuit x peak pressure)

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61
Q

Which bellows is safer?

A

Ascending

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62
Q

Which modes of ventilation are best for the LMA?

A

SIMV, PSV

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63
Q

A jet ventilator functions based on the ____ effect

A

Venturi

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64
Q

Critical temp of N2O

A

36.5

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65
Q

The unidirectional valves must e placed between the ___ and ___

A

patient
Reservoir bag

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66
Q

How much pressure for low pressure test?

A

-65cmh2o for 10 seconds

67
Q

Failsafe tasks

A

30cmh2o- alarm
20cmh2o- stops n2o output

68
Q

What two steps if you suspect a pipeline crossover

A

1- open oxygen tank
2- close wall supply

69
Q

Other names for flowmeters

A

Thorpe tubes
Rotameter

70
Q

Where to read flowmeter indicators

A

Ball-middle
All others- top

71
Q

Vapor pressure of iso, sevo, des

A

Iso- 238
Sevo- 157
Des- 660

72
Q

Most common cause of a vaporizer leak?

A

Loose filler cap which is caught by a low pressure leak test

73
Q

Estimates liquid anesthetic usage formula

A

% of anesthetic x FGF x 3

74
Q

What causes the pumping effect?

A

PPV
O2 flush

75
Q

What is the boiling point of Des?

A

23 C

76
Q

Tec 6

A

Des
39 c, 2atm
Electronic
injects
non elevation compensated
Turn up at elevation

77
Q

Why is the ascending bellow safer?

A

It will not rise if there is a leak/ crack, so it will be easily detected

78
Q

How much peep does the gas driven bellow vs the piston ventilator ass?

A

Gas driven- 3
Piston- non

79
Q

What is the primary base of soda lima?

A

Sodium hydroxide NAOH
Neutralizes CO2

80
Q

What PH will change the soda lime to purple?

A

10.3

81
Q

Sevo + dessicated soda lime =

A

Compound A

82
Q

Order of carbon monoxide production from volatile agents and dessicated soda lime

A

Des
Iso
Sevo

83
Q

open vs closed relief valves

A

open- active only, no need for any pressure relief valve
closed active- (needs positive and negative negative pressure relief)
closed passive- (needs positive pressure relief only)

84
Q

High and low system parts

A

H- cyclinder x 3, yoke x 2
L- vaporizer, CGO, check valve, flowmeter tubes

85
Q

What does the hig pressure leak test assess?

A

Low pressure system and breathing circuit

86
Q

When will the failsafe not alarm?

A

Pipeline crossover
Flowmeter leak

87
Q

When will hypoxia prevention device not alarm?

A

Pipeline crossover
Flowmeter leak
3rd gas administration
Defective mechanic / pneumatic components

88
Q

Types of oxygen analyzers

A

Galvanic- Needs daily calibration
Pragmatic- faster, self calibrating

89
Q

What are the risks of a leak in the bellow?

A

Barotrauma
Alteration in concentration

90
Q

How to prevent rebreathing in the Bain system

A

FGF needs to be 2.5x minute ventilations

91
Q

Best breathing system for spontaneous vs mechanical ventilations

A

ADB- spont
DBA- mech vent

92
Q

Intrinsic muslces of the larynx and their function

A

Chubby tired leprochauns piss terrible venom
Cricothyroid- cords tense/ elongate
Thyroaryetnoids- shorten/ relax
Lateral cricoaryetnoids-adduction
Posterior cricoaryetnoids- abduction
Traverse aryetnoids
Vocalis- shorten/ relax

93
Q

Risk factors for either RLN to be damaged

A

Overinflation of ETT
Tumor
Excessive neck stretching
Neck surgery- thyroidectomy

94
Q

Risk factors for injury to the L RLN

A

LA enlargement
PDA ligation
AAA
Thoracic tumor

95
Q

Pharmacologic tx for laryngospasm

A

Adult/kids - succ 1mg/kg IV or 4mg/kg IM
Neonates- 2mg/kg iv or 5mg/kg IM
0.02mg/kg atropine in kids under 5

96
Q

Valsalva vs muller

A

opposites

97
Q

How much pressure for sellick maneuver

A

20N before induction
40N after induction

98
Q

Anesthetic considerations for ludwigs angina?

A

Bacterial infection in mouth
Awake nasal intubation or trach

99
Q

HELP aligns what two axis?

A

external auditory
Sternum

100
Q

Contraindications for NPA

A

Cribiform plate injury (lefort 2 or 3)
Coagulopathy
Nasal fracture
Previous caldwell luc
Previous transphenoidal hypophysectomy

101
Q

Max cuff pressure in LMA

A

60cm h2o

102
Q

Max PPV pressure in LMA

A

20cm h2o

103
Q

Which meds to give for extubation of a difficult airway

A

BB, CCB, vasodilators
Lidocaine
Opioids

104
Q

Strongest contraindication to an LMA

A

Tracheomalacia

105
Q

What angle is the glidescope

A

60

106
Q

Which local anesthetic has the fastest onset for the oral mucosa?

A

Benzocaine

107
Q

What position for intubation with the LMA Fastrach?

A

Neutral with a pillow

108
Q

Steps in airway fire

A

Remove ETT
Turn off gas
Pour saline
Reestablish airway

109
Q

Most important factor from BONES

A

Beard

110
Q

When is cricoid pressure contraindicated?

A

Active vomiting
C spine fracture

111
Q

The order of laryngospasm treatment

A

Fio2 1.0
Remove offending stimulus
Deepend anesthetic
CPAP
SUCC 1mg/kg iv or 4mg/kg im

112
Q

What is the largest ETT an LMA Fastrach can intubate?

A

8.5

113
Q

What do the roots of the brachial plexus pass thru?

A

Between the anterior and middle scalene muscles

114
Q

What do the brachial plexus trunks pass thru?

A

Lateral border of scalenes

115
Q

What do the brachial plexus divisions pass thru?

A

Between the clavicle and first rib

116
Q

Where do the cords of the brachial plexus pass thru?

A

Under the pec minor

117
Q

Where do the branches of the brachial plexus diverge?

A

Axilla

118
Q

Suprascapular branches of the brachial plexus

A

Long thoracic c5 c6 c7
Suprascapular c5 c6
Dorsal scapular c5

119
Q

Infraclavicular branches of the brachial plexus

A

Lateral pectoral
Medial pectoral

120
Q

Supraclavicular indications

A

Clavicular
Carotid endarectomy

121
Q

Intercostobrachial indications

A

Arm pain from bier block

122
Q

Dermatome of upper arm

A

c4- superior delt
c6- lateral delt, thumb
c7- 2 and 3 finger
c8- 4 and 5 finger
t1- medial arm
t2- axilla

123
Q

Brachial plexus combined sensory and motor peripheral nerves

A

MARMU

124
Q

Brachial plexus sensory peripheral nerves

A

Medial brachial cutaneous
Medial antebrachial cutaneous

125
Q

Clinical assessment of brachial plexus blockade

A

Push er- radial- elbow extension
Pull em- musculocutaneous- bicep contraction
Pinch u- ulnar- pinch pinky
Pinch me- median- pinch 2nd digit

126
Q

Interscalene indications, side effects, and volume

A

Shoulder, upper arm, clavicle (although it may need a superficial cervical plexus block as well)
phrenic nerve paralysis, horners, hypo-brady episode (prevent with BB), total spinal, RLN injury from large volume
7-15 ml

127
Q

When is a pneumo from a block a higher risk?

A

Tall patients

128
Q

SS of pneumo

A

Dyspnea
Chest pain
Coughing

129
Q

Infraclavicular indications, side effects, and volume

A

Upper arm, elbow, wrist, hand- good alt for supra (respiratory) and axilla (mobility)
LAST, pneumo, PAIN bc all pec muscles
20-30 ml

130
Q

Axillary block indications, side effects, and volume

A

Forearm and hand, full stomach,
Musculocutaneous injury,
LAST
15-20 ml

131
Q

Distal blocks indication, SE, volume

A

Used in forearm or hand surgery if nerves were missed in brachial plexus block
Radial- 5ml/ 10ml low
Ulnar- 5ml high or low
Median- 5ml high or low (NOT IN CARPAL TUNNEL PT, no epi)

132
Q

Volume for digital nerve block

A

3 ml no epi

133
Q

Volume for bier block, what drug not to use

A

50ml NO BUPIVICAINE NO EPI

134
Q

Max inflation of bier block tourniquet

A

2hr

135
Q

Biggest risk of IVRA

A

LAST- wait 20 minutes at least

136
Q

IVRA pressure

A

250 upper
350 lower

137
Q

Contraindications to IVRA

A

Crush injury/ compound
No peripheral access
Cellulitis
Sickle cell
PVD

138
Q

Which artery will be at risk for LAST during a supraclavicular block?

A

Subclavian

139
Q

Landmarks for a low median nerve block

A

Flexor palmaris longus tendon
Flexor carpi radialis tendon

140
Q

What angle of insertion for different parts of the spine durine neuraxial anesthesia

A

Lumbar- 90 degrees
Thoracic- 45 degrees

141
Q

Spine landmarks

A

C7- cervical prominens
T3/ T7- top/ bottom of scapula
L1- 10th rib
L4- superior iliac crest
S2- superior iliac spine

142
Q

What is the hardest and thickest layer in the spine?

A

Dura- collagen and elastic fibers

143
Q

Epidural space borders

A

Cranial- Foramen magnum
Caudal- Sacrococcygeal ligament
Anterior- Ligamentum flavium
Posterior- posterior ligament
Lateral- pedicles

144
Q

Batsons plexus

A

Epidural veins
Can become engorged in pregnancies and obese, will increase risk of needle injury

145
Q

3 meninge layers

A

DAP

146
Q

Epidural needles

A

Crawford- 0
Hustead- 15
Tuohy- 30

147
Q

Spinal needles

A

Cutting- Quincke, pitkin
Pencil- Sprotte Whitaker Pencan
Rounded- Greene

148
Q

How far to inject for epidural

A

4-6cm

149
Q

Onset and duration of spinals

A

Rapid
<2 hours

150
Q

Sequence of blocks and reversal

A

Sympathetic
slow pain, temperature, touch
fast pain, temperature, touch
Touch/ pressure
motor/ proprioception

151
Q

What determines the spread of a spinal

A

Baricity, dose, site, position

152
Q

What determines the spread of an epidural?

A

Volume, dose, level

153
Q

What determines the duration of a spinal?

A

LA used, dose

154
Q

What determines the duration of an epidural?

A

LA used

155
Q

Benefits of hyperbaric vs isobaric

A

Hyper- denser, consistent block
Iso- longer blocks for non pregnants

156
Q

How does age affect spinals?

A

Older age causes a slower onset and longer duration

157
Q

What patient variables dont effect spinal spread?

A

Height
Weight
BMI
Spine length

158
Q

How does gender affect spinal?

A

Females and pregnant- increased motor block with bupivicaine

159
Q

How does pregnancy affect a spinal?

A

Pregnant patients develop a higher level of sensory block

160
Q
A
161
Q

Supraclavicular indications, side effects, and volume

A

Upper arm, elbow, wrist, hand (no shoulder)
Pneumo (highesy risk), subclavian artery puncture, LAT,
20-25 ml

162
Q

Biggest ETT that can fit inside an LMA

A

3.5
4
4.5
5
6
6
7

163
Q

Thyromental distance assesses ___

A

Submandibular space
6-9cm

AP + Phys (38 decks)

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