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ABA Advanced Exam > General > Flashcards

General Flashcards

1
Q

Signs and symptoms of cholinergic crisis

A
  • Salivation
  • Miosis
  • Bradycardia
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2
Q

ACC/AHA criteria to diagnosis pulmonary hypertension

A

Requires right-heart catheterization and the following findings:

  1. Resting mPAP > 25 mmHg
  2. PCWP/LAP < 15 mmHg
  3. PVR > 3 Woods unit (<500 dynes)
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3
Q

Adverse effects from celiac plexus neurolytic blocks

A
  • Hypotension
  • Diarrhea
  • Hiccups
  • Retroperitoneal bleeding
  • Abdominal aortc dissection
  • Transient motor paralysis
  • Paraplegia
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4
Q

Factors that increase local anesthetic onset time

A
  • Lower pKa/lipid solubility
  • Increased solution pH
  • Increased LA concentration
  • Increased LA dose
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5
Q

Bainbridge reflex

A

Ultimately increases HR when intravascular volume increases

  • mechanoreceptors in RIGHT and LEFT ATRIA sense increased intravascular volume
  • signal carried by VAGUS nerve to medulla
  • increased sympathetic discharge at SA node with decreased parasympathetic discharge
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6
Q

Bezold-Jarisch reflex

A

Ultimately decreases HR due to intravascular volume depletion

  • mechano/chemoreceptors in VENTRICLES sense decreased filling
  • decreased sympathetic discharge
  • results in bradycardia, vasodilation and worsening HoTN
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7
Q

Causes of increased PVR

A
  • decreased PaO2
  • increased PaCO2
  • acidoses
  • increased airway pressure
  • hypothermia
  • vasoconstrictors (phenylephrine)
  • polycythemia
  • “light” anesthesia
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8
Q

Causes of increased SVR

A
  • low cardiac output
  • “light” anesthesia
  • alpha adrenergic agonist (phenylephrine)
  • hypothermia
  • acidosis
  • polycythemia
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9
Q

Classification of burn injury

A
  • First degree - superficial, confined to epidermis
  • Partial thickness (second degree) - epidermis and dermis
  1. superficial dermal - upper dermis
  2. deep dermal - deep dermis (req’s excision, grafting)
  • Full thickness (third degree) - full destruction of epidermis and dermis
    1. Fourth degree - involves muscle, fascia, bone
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10
Q

Clinical manifestation of serotonin syndrome

A

Mild to Life-threatening:

  • akathasia (restlessness)
  • tremor
  • AMS
  • inducible clonus
  • sustained clonus
  • hypertonia/rigidity
  • hyperthermia
  • cardiovascular collapse
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11
Q

Complications of retrobulbar block

A

MOST COMMON= retrobulbar hemorrhage

  • increased IOP resulting in proptosis
  • oculocardiac reflex
  • central retinal artery occlusion (sudden, PAINLESS monocular vision loss)
  1. inadvertant brainstem anesthesia
  2. postop strabismus (d/t intramuscular injection of LA)
  3. globe puncture
  4. optic nerve damage
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12
Q

Consequence of LV overload due to pressure

A

increased end-systolic wall stress –> parallel replication of sarcomeres –> increased wall thickeness –> concentric hypertrophy –> HFpEF

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13
Q

Consequence of LV overload due to volume

A

increased end-diastolic wall stress –> series replication of sarcomeres –> wall dilation –> eccentric hypertrophy –> HFrEF

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14
Q

Contraindications to intraoperative autologous hemodilution during cardiopulmonary bypass

A
  • perioperative anemia
  • unstable angina
  • left main disease
  • aortic stenois
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15
Q

Contraindications to retrobulbar and peribulbar blocks

A
  • Age <15 yrs
  • Surgery >90 min
  • AMS, cognitive dysfxn
  • Uncontrolled cough, tremors, movement d/o
  • Bleeding, coagulopathies, use of anticoagulation
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16
Q

Conversion ratio of HM, PO:IV

A

5:1

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17
Q

Describe anatomic landmarks of the Petit triangle used for TAP block

A

Lumbar triangle:

  • iliac crest = inferior wall
  • external oblique = anterior wall
  • latismus dorsi = posterior wall
  • triangle floor = external oblique fascia
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18
Q

Describe benefits of isovolemic hemodilution

A
  • Increased cardiac output
  • Increased tissue oxygen extraction
  • Decreased sheer forces in capillary beds
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19
Q

Describe considerations in drug therapy during resuscitation for LAST

A
  • Avoid vasopressin
  • Administer reduced epinephrine dose
  • Avoid calcium channel and beta blocker
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20
Q

Describe ECG leads with myocardial territories

A
  • Inferior= II, III, aVF
  • Septal= V1, V2
  • Anterior= V3, V4
  • Lateral= I, aVL, V5, V6
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21
Q

Describe hemodynamic effects of isovolemic hemodilution. Why?

A

Increased CO:

  • decreased blood viscosity
  • sympathetic surge d/t anemia and relative hypoxemia
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22
Q

Describe the pathology associated with Ebstein’s anomaly

A

Ebstein’s anomaly affects the tricuspid valve and right ventricle and can result in a hypoplastic right ventricle, enlarged right atrium, and a redundant anterior tricuspid valve leaflet. Most patients also have an atrial septal defect.

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23
Q

Describe wind-up phenomenon

A

Caused by repeated stimulation of peripheral C fibers resulting in increased action potentials at the dorsal horn causing an amplified pain response.

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24
Q

Differential diagnosis: Irregularly irregular ECG rhythm

A
  • atrial fibrillation
  • multifocal atrial tachycardia
  • wandering atrial pacemaker
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25
Q

Differential diagnosis: PEA arrest

A

H&T’s

  • Hypoxemia
  • (H+) acidosis
  • Hypothermia
  • Hyper/hypo kalemia/calcemia
  • Hypovolemia
  • Tamponade
  • Tension PTX
  • Thrombosis (MI, PE)
  • Toxins
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26
Q

Drugs and factors that potentiate NMBD

A
  • inhaled anesthetics
  • aminoglycoside abx (gentamycin, neomysin, tobramycin, streptomycin)
  • hypothermia
  • magnesium
  • lithium
  • local anesthetics
  • ACUTE phenytoin use
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27
Q

ECG: Describe criteria to diagnosis axis deviation

A
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28
Q

ECG: Diagnostic criteria for left bundle branch block (LBBB)

A
  • QRS >120 msec
  • dominant S wave in V1
  • monophasic R wave lateral leads (I, aVL, V5-V6)
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29
Q

ECG: Diagnostic criteria for right bundle branch block (RBBB)

A
  • QRS >120 msec
  • RSR’ in V1-V3 (M shaped QRS)
  • wide, slurred S wave in lateral leads (I, aVL, V5-V6)
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30
Q

Estimate the progression of aortic stenosis by year

A

Approximately 0.1cm2 per year progression

ie: AV area 1.0cm2; 5 yrs later would be 0.5cm2

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31
Q

Factors that cause overdamping of arterial line waveform

A

Overdamping results in underestimated SBP, overestimated DBP, unaffected MAP and loss of dicrotic notch

  • kinked tubing
  • increased compliance of tubing
  • increase length of tubing
  • blood clot
  • air bubble
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32
Q

Factors that increase r/o desaturation during OLV

A
  • High perfusion and/or ventilation on preop V/Q scan
  • Poor PaO2 during 2 lung ventilation
  • Right-sided thoracotomy
  • Normal PFTs
  • Restrictive lung disease
  • Supine positioning during OLV
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33
Q

In terms of bronchoscopy, describe anatomic landmarks for carina

A
  • Anterior = sternal angle
  • Posterior = 5th thoracic vertebra
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34
Q

Indications for PA catheter placement

A
  • evaluation/diagnosis pulm HTN
  • distinguish etiology of shock
  • assess volume status
  • evaluate cardiac shunt
  • evaluate right-sided HF
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35
Q

Main determinant for closure of ductus arteriosus in neonates?

A

Increasing PaO2 > 50 mmHg (leads to smooth muscles within the vessel to constrict, leading to its closure and loss of patency)

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36
Q

Management of tracheoesophageal fistula in newborn

A
  • IV access, correct anemia, electrolytles
  • T&C
  • ECHO
  • +/- gastrotomy tube (vents the stomach, best utlized if difficulty ventilating d/t ab distention)
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37
Q

Name the adverse side-effects of succinylcholine

A
  • Cardiac arrythmias:
  • sinus bradycardia
  • junctional rhythm
  • sinus arrest
  • Fasciculations, myalgias, trismus (lockjaw)
  • Hyperkalemia
  • Myoglobinuria
  • Increased intraocular pressue
  • Increased intragastric pressure
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38
Q

Name the benzylisoquinolinium ndNMBD

A
  • Cisastricurium
  • Atracurium
  • Mivacurium
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39
Q

Name the cardiovascular criteria for positive epidural test dose with epinephrine in pediatric patients under GA

A

Changes that mark intravascular injection:

  • elevation in T-wave amplitude by 25% (most sensitive)
  • increase in HR by 10 bpm
  • increase in SBP by 15 mmHg
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40
Q

Name the largest branch of the lumbar plexus

A

Femoral nerve

41
Q

Name the most important accessory muscles for ventilation

A

*Diaphragm is main muscle of ventilation

  • Inspiration = cervical strap muscles (scalenes, sternocleidomastoids)
  • Expiration = abdominal muscles
42
Q

Name the reversal agent for dabigatran

A

Idarucizumab

43
Q

Name the aminosteroid ndNMBD

A
  • Pancuronium
  • Rocuronium
  • Vecuronium
44
Q

Nerve distribution commonly spared with supraclavicular block

A

Ulnar nerve distribution

  • medial surface of hand
  • 5th digit
45
Q

Order of NMBD potentiation by inhaled anesthetics

A

Desflurane > Sevoflurane > Isoflurane > Nitrous oxide

46
Q

Oxygen content calculation

A

CaO2 = (1.34 x Hgb x SaO2) + (0.003 x PaO2)

47
Q

Pathogen most responsible for croup

A

Parainfluenza virus

48
Q

Pregabalin:

MOA

Side-effects

A

MOA:

  • binds the alpha-2 delta subunit of the presynaptic N-type voltage-gated calcium channels

Side-effects:

  • increases slow wave sleep (somnolence) but is correlated with restorative sleep and less nighttime awakening
  • fluid retention and peripheral edema (contraindicated in pts with CHF)
49
Q

Principle determinants of myocardial oxygen demand

A
  • contractility
  • wall tension
50
Q

Recommendations for DAPT duration and elective non-cardiac surgery

A
  • BMS- 30 days
  • DES- 6 months*

*unless risk of delayed surgery too high, then DES 3-6 months

51
Q

Rectus sheath block nerve target

A

Thoracic intercostal nerve

52
Q

Respiratory effects with spinal anesthetic resulting in T4 sensory blockade

A
  • Minimal to no effect on TV
  • Decreased peak expiratory flow
  • Decreased expiratory reserve volume, therefore, reduced vital capacity
53
Q

Risk factors of IV Amiodarone:

short-term, long term

A

Short term:

  • bradycardia
  • HoTN
  • phlebitis

Long term:

  • visual disturbance
  • skin discoloration (gray-blue)
  • thyroid dfxn
  • pulm toxicity
54
Q

Risk factors of retinopathy of prematurity

A
  • Prematurity (GA <31 weeks)
  • Low birth weight (<1250 grams)
  • Hyperoxia/hypoxia
  • Low IGF-1 levels (insulin-like growth factor)
  • Hyperglycemia
55
Q

Risks of arterial line placement

A
  • hematoma
  • ischemia
  • pseudoaneurysm
  • AV fistula
  • arterial dissection
56
Q

Side-effects of supraclavicular block

A

Horner’s syndrome

  • ipsilateral ptosis
  • miosis
  • anhydrosis

Phrenic nerve block

  • Dyspnea
57
Q

Structures innervated by medial branch of dorsal rami

A
  • Facet joint
  • Multifidus muscle (connect spinous process to lamina)
  • Interspinous ligament
58
Q

Tx: Air embolism

A
  • Discontinue nitrous oxide
  • Aspiration through a right heart catheter
  • Supplemental oxygen
  • Prevent further air entry into circulation (flood surgical field with saline, jugular compression, lower head of bed in neurosurgical cases)
  • Left lateral decubitus position (allows air to move toward right ventricular apex, thereby relieving the obstruction of the pulmonary outflow tract)
59
Q

What are absolute indications for GI prophylaxis (think SICU)?

A
  • coagulopathy (plt <50k, INR > 1.5, aPTT >2x nl
  • mechanical ventilation > 48hrs
60
Q

What conditions increase the volume of Zone 1 (West zones) of pulmonary circulation?

A

Decreased perfusion:

  • low CO
  • hypotension
  • PE
  • upright positioning

Increased alveolar pressure:

  • PEEP
  • positive pressure ventilation

Decreased vasculature:

  • emphysema
  • pulmonary fibrosis
61
Q

What constitutes anatomic dead space?

A

Volume of the regions of the airway that histologically can’t participate in gas exchange:

  • upper airways (oral cavity, nasopharynx, larynx)
  • cartilaginous airways (trachea, bronchi, membraneous bronchioles)
  • measured via single-breath nitrogen wash-out test (Fowler’s method)
  • ~2mL/kg ideal body wt
62
Q

What is an absolute contraindication for single-lung transplant (vs double-lung transplant)?

A

Infectious lung dz, ie: CF, bronchiectasis

63
Q

What is normal chest wall compliance?

How is it calculated?

A

100 mL/cm H20

C chest wall = change chest vol / change transthoracic pressure

64
Q

What is normal lung compliance?

How is it calculated?

A

150-200 mL/cm H20

Clung = change lung volume/ change transpulmonary pressure

65
Q

What is the blood supply to the AV node?

A

RCA (85% of population)

66
Q

When should rapid deflation of IABP occur?

A
  • Peak of R wave on ECG
  • Just before systolic upstroke on arterial waveform
67
Q

When should rapid inflation occur of IABP?

A
  • Middle of the T wave on ECG
  • Dicrotic notch on arterial waveform
68
Q

Which abx class does NOT augment neuromuscular blockade?

A

Macrolides:

  • azithromycin
  • erythromycin
  • clarithromycin
69
Q

Which area of the heart is most vulnerable to ischemia?

Why?

A

Subendocardium of LV

  • directly exposed to intracavitary pressure
  • greatest metabolic requirements due to systolic shortening
70
Q

Which chamber do cardiac myxomas typically arise?

A

Left atrium (70%)

71
Q

Which coronary artery provide blood supply to AV node?

72
Q

Which coronary artery provides blood supply to SA node?

A

59%- RCA

38%- LCA

3%- both

73
Q

Which drug should be avoided in tx LAST?

Why?

A

Vasopressin

Afterload augmentation w/o increased ionotropy would worsen cardiovascular compromise d/t LAST

74
Q

Which factor has the greatest effect on spread of local anesthetic in the epidural space?

Why?

A

Age

  • Dura mater is more permeable in the elderly due to increased number of arachnoid villi providing more surface area for permeation of local anesthetic to diffuse into subarachnoid space
  • Compliance of epidural space increases with age, therefore increasing spread of sensory blockade
  • Decreased number of myelinated nerve fibers in the elderly may allow local anesthetic to more easily penetrate nerve roots
76
Q

Which nerve is not anesthetized via supraclavicular (brachial plexus) block?

A

Intercostobrachial nerve (T2; skin of the proximal part of the medial side of the arm)

77
Q

Which nerve is often spared during retrobulbar block?

A

CN VII, Facial nerve

  • Pt can close eyelid (orbicularis oculi) but not open eyelid (levator muscle, CN III/oculomotor nerve)
78
Q

Which nerve supplies sensory innervation of cornea, iris and ciliary body?

A

Nasociliary nerve (branch of opthalmic nerve, trigeminal nerve V1)

79
Q

Which NMBD inhibits reuptake of norepinephrine by adrenergic nerves?

A

Pancuronium

80
Q

Which patient factor is most implicated in development of cauda equina syndrome following spinal anesthesia?

Why?

A

Hx of spinal stenosis

  • Increases risk of local anesthetic accumulation and subsequent injury to nerves.
81
Q

Which valvular disease is commonly associated with bicuspid aortic stenosis? Why?

A

Aortic regurgitation

Aortic root post-stenotic

82
Q

Why do [some] anticonvulsant drugs interfere with OCP efficacy?

A

Administration induces CYP3A4 expression. CYP3A4 is the primary metabolic pathway for estrogen and progesterone, especially ethinyl estradiol, which can reduce the efficacy of OCP.

Anticonvulsants that interfere with OCPs:

  • Topiramate
  • Carbamazepine
  • Lamotrigine
  • Phenytoin
83
Q

Risks of repeated plasmapheresis

A
  • Infection
  • Hypotension
  • Pulmonary embolism
84
Q

Factors that predict postop ventilation requirement following transsternal thymectomy

A
  • Disease (myasthenia gravis) duration >6 yrs
  • H/O COPD
  • Daily pyridostigmine dose >750mg
  • VC <2.9L
85
Q

Treatment for cerebral vasospasm

A

Triple H therapy:

  • hypervolemia (increase CVP by 10 mmHg)
  • hypertension (increase CPP)
  • hemodilution (decrease blood viscosity, improve CBF)

*Nimodipine is a prophylactic drug used to prevent vasospasm

86
Q

Inherited risk factors for intracranial aneurysms

A
  • Polycystic kidney dz
  • Type IV Ehlers-Danlos
  • Hereditary hemorrhagic telangectasia
  • Neurofibromatosis type I
  • coarctation of the aorta
  • Pheochromocytoma
  • Klinfelter’s syndrome
  • Tuberous sclerosis
  • Noonan’s syndrome
87
Q

Non-inherited risk factors for intracranial aneurysms

A
  • Age >50
  • Female
  • Smoking
  • Cocaine use
  • Head trauma
  • Septic emboli
  • HTN
  • Alcohol use disorder
  • OCPs
  • HLD
88
Q

Hyperkalemic Periodic Paralysis:

Triggers

A
  • rest after exercise (elevation of ECF potassium)
  • potassium-rich foods
  • stress
  • alcohol
  • fatigue
  • hypothermia
  • fasting
  • pregnancy
  • corticosteroids
89
Q

Hyperkalemic Periodic Paralysis:

Interventions during attacks

A
  • glucose ingestion
  • inhaled albuterol
  • thiazide diuretics
  • acetazolamide
90
Q

Describe the 2 main causes of succinylcholine-induced hyperkalemia

A
  1. extrajunctional receptors (burns, spinal cord injury, immobile)
  2. rhabdomyolysis (seen in muscular dystrophy)
91
Q

Anesthetic agents and effects on CBF, CRMO2

92
Q

Calcitriol:

MOA

A

Active form of vitamin D, increasing GI uptake of calcium and decreasing renal calcium excretion; used in treatment of hypoparathyroidism

93
Q

Signs of venous air embolism

A
  • increase in dead space (decreased EtCO2, elevated PaCO2)
  • HoTN
  • Tachycardia
  • Acute RV failure (flash pulmonary edema, hypoxia)
94
Q

Describe differences between hypo vs hyper kalemic periodic paralysis

95
Q

Name examples of a potassium-wasting diuretic and examples of a potassium-sparing diuretic

A

Wasting:

  • thiazides (HCTZ, chlorthalidone)
  • loop diuretics (furosemide, torsemide, ethacyrnic acid)

Sparing: “SEAT”

  • aldo antagonist: spironolactone, eplerenone
  • ENaC blockers: amiloride
96
Q

Which neuromonitoring technique is most sensitive to volatile anesthetics?

A

Visual-evoked potentials (VEP)

97
Q

Which neuromonitoring technique is least sensitive to volatile anesthetics?

A

Auditory-evoked potentials (AEP)

98
Q

Pathophysiology:

  • tetanus
  • botulism
  • diptheria
  • pertussis
A

Tetanus:

  • clostridium tetani, inhibits neurotransmitter release from inhibitory neurons in CNS

Botulism:

  • clostridium botulinum, inhibition of AcH release from NMJ

Diptheria:

  • inhibition of elongation factor 2 of transcription

Pertussis:

  • bordetella pertussis, ribosylation of Gi protein inhibits the inhibitor of cyclic AMP

ABA Advanced Exam (1 decks)

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