General Anesthesia Flashcards

1
Q

What treatments have been proven to be effective in preventing contrast nephropathy?

A
  • Continuous hemofiltration
  • Oral N-acetylcysteine
  • Bicarbonate Infusion
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2
Q

How many colony-forming units (CFU) are required from a quantitative bronchoalveolar lavage to make the diagnosis of pneumonia?

A

10,000 CFU/mL

  • For endotracheal aspirates the cutoff is 1,000,000 CFU/mL
  • For protected brush specimen the cutoff is 1,000 CFU/mL
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3
Q

What nerves need to be blocked for an awake intubation?

A

Superior laryngeal nerve (vagus nerve) which supplies sensation to the hypo pharynx (internal branches): epiglottis, base of tongue, supraglottic mucosa, thyroepiglottic joint and the cricothyroid joint.

Glossopharyngeal nerve (IX) which innervates the roof of the pharynx, tonsils, and undersurface of the soft palate.

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4
Q

What is the most common initial manifestation of malignant hyperthermia (MH)?

A

Increased PetCO2

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5
Q

The initial reduction in core temperature during general anesthesia is cause by?

A

Redistribution of heat from the core to the periphery

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6
Q

All burn patients should receive 100% oxygen until CoHgb is at what percentage?

A

Until COHgb is less than 7%.

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7
Q

What are the innervations (afferent and efferent) for the oculocardiac reflex?

A

Afferent: trigeminal nerve
Efferent: vagus nerve

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8
Q

What coagulation factors are produced outside of the liver?

A

Factor VIII and von Willebrand are “endothelium-derived procoagulant factors” and are increased in cirrhosis

An extrahepatic source of factor VII has also been identified

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9
Q

What area of the brain is effected by Parkinson’s disease? What are the symptoms?

A

The fundamental lesion in Parkinson’s is in the basal ganglia.

Classic symptoms:
drawn face
fixed expressions
lead pipe rigidity
nonintentional tremor which diminishes with activity
initiation of movement is difficult as is termination

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10
Q

What are the signs and symptoms of carcinoid syndrome and how is it diagnosed?

A

Carcinoid tumors release vasoactive peptides into the systemic circulation causing symptoms when the tumor metastasizes from its site of origin (usually the appendix or ileum) to the liver or when its venous drainage returns to the heart bypassing the liver.

Hormones released include: SEROTONIN, histamine, and kinins

Symptoms include: cutaneous flushing (sweating), bronchoconstriction, hypotension, diarrhea

Signs: urinary 5-HIAA levels (a metabolite of serotonin)
right sided heart failure, tricuspid regurgitation (common) or stenosis, pulmonary regurgitation/stenosis (right-sided fibrotic endocardial lesions)I

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11
Q

What is the treatment for carcinoid syndrome?

A

Octreotide (a somatostatin analogue) is the mainstay of peri-op tx. It binds to SSTR subtypes 2 & 5 inhibiting secretion of various peptide hormones (i.e. serotonin) (t 1/2 1-3 minutes)

Subcutaneous administration with max plasma concentration after 30 mins. Elimination half-life of 1.5-2 hours.

Elimination in 2 phases with half-lives of 10 and 90 minutes respectively

Cyproheptadine is a serotonin antagonist used in serotonin syndrome.

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12
Q

What are the criteria for diagnosing pre-renal acute renal injury (ARI)?

A
Urine osmolality > 500 mOsm/kg
Bland (hyaline casts) sediment
Urine Na+ < 10 mEq/L (due to activation of the renin angiotensin aldosterone system (RAAS)
FENa < 1%
No to minimal amount of protein in urine
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13
Q

How is total lung capacity(TLC) affected in patients with obstructive lung disease? FVC? FEV1/FVC ratio? FEF 25% to 75%?

A

TLC is normal or increased due to air trapping and increased residual volume (RV)

Forced vital capacity (FVC) is also increased or normal

FEV1/FVC ratio is decreased (since FEV1 is decreased)

FEF 25% - 75% is decreased due to airway resistance

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14
Q

How does restrictive lung disease effect TLC? FVC? FEV1/FVC ratio?

A

Restrictive disease is a proportional decrease in ALL lung volumes, which results in a normal FEV1/FVC ratio

Decreases in TLC, FVC, FEV1, and FRC

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15
Q

What are the increased anesthetic risks associated with patients with Down syndrome? What disease(s) are usually associated with these patients?

A

They have an increased risk of airway problems: macroglossia, atlantoaxial instability, subglottic stenosis, and OSA.

They also have an increased risk of HYPOthyrodiism, polycythemia at birth, and diabetes mellitus.

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16
Q

In liver transplants, what are the possible physiologic derangement that may need to be addressed at the time of reperfusion?

A

1) With the removal of the portal vein clamp and reperfusion of the transplanted liver, the residual cold, potassium-rich preservative solution from the donor liver enters the vena cava and boluses directly to the recipient’s heart.

Prophylactic administration of sodium bicarbonate and calcium may ameliorate the hemodynamic consequences of hyperkalemia

2) Subsequent removal of all naval clamps results in reperfusion syndrome in 30% of recipients; hemodynamic instability with hypotension due to vasodilatation is treated with epinephrine or phenylephrine (norepinephrine, epinephrine, vasopressin infusions) and 3) pulmonary hypertension with nitric oxide or nitroglycerine

At this point, a immunosuppressant steroid is administered, usually methylprednisolone.

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17
Q

What is the first drug choice in treating RV failure with elevated PA pressures following reperfusion in a liver transplant?

A

Epinephrine is the first drug choice to improve RV contractility and increase systemic blood pressure (primary focus)

Nitric oxide would not increase the systemic blood pressure; nitroglycerin could not be the sole agent (although both are useful in decreasing PA pressure)

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18
Q

What surgical procedures are associated with an increased risk of PONV?

A
Septal nasal submucosa resection
Tonisllectomy and adenoidectomy
Rotator cuff repair
Knee arthroscopy
Laproscopic cholecystectomy
Lumpectomy
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19
Q

What is the storage life of red blood cells preserved with CPDA-1 and ADSOL?

A

42 days

ADSOL (AS-1) is a preservative added to CPD-packed red blood cells which is used to increase the shelf-life of the unit

*Nutricel (AS-3) and Optisol (AS-5) are other common solutions that will preserve RBCs to 42 days.

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20
Q

What is the storage life of red blood cells preserved with CPD, ACD, and CP2D alone?

A

21 days stored at 1-6 degree Celsius

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21
Q

What is the storage life of red blood cells preserved with CPDA-1 alone?

A

CPDA-1 solution increases the shelf-life to 35 days

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22
Q

What is the storage life of red blood cells that are frozen?

A

up to 10 years

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23
Q

How does activated protein C aid in the treatment of septic shock?

A

Patients with septic shock show clinical or subclinical manifestations of intravascular disseminated coagulation with consumption coagulopathy. Recombinant activated protein C can be given to patients with septic shock to modulate sepsis-induced coagulopathy.

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24
Q

What is the most common transfusion-related infection in the US?

A

Cytomegalovirus (CMV)

The incidence of transfusion-transmitted CMV disease is dependent on the type of blood product (RBC vs. platelets) and the use of leukoreduction (CMV is latent in cells of the monocyte/macrophage lineage and it is these cells that can support CMV replication)

2.4% vs. seronegative blood components

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25
Q

What are the risk of acquiring West Nile virus vs. HIV vs. HTLV vs. Hepatitis C virus following blood transfusions?

A

West Nile Virus: 1:1 million

Hepatitis C: 1:1.2 million

HIV: 1:1.5 million to 1:3 million

HTLV: 1:3 million

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26
Q

Following a parathyroidectomy, when would postoperative hypocalcemia reach a nadir? What would the symptoms be?

A

3 to 7 days after surgery

Symptoms of hypocalcemia include:
spasms
cramps
seizures
stridor/apnea (if severe)
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27
Q

What are the symptoms of hypercalcemia?

A

Stones (renal function)
Bones (pain)
Groans (abdominal pain, nausea/vomiting)
Throans (polyuria, decreased volume status)
Psychiatric overtones (depression, anxiety, cognitive dysfunction)

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28
Q

What are the hallmark signs associated with fat embolism?

A

Petechial rash over the chest is pathognomonic for fat embolism

Decreased room air saturation

Decreased end-tidal carbon dioxide levels

Intraalveolar hemorrhage can occur in the first 24-48 hours

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29
Q

Diabeties Insipidus (DI) vs. Syndrome of Inappropriate ADH (SIADH); presentation, clinical signs

A

Both are common postoperative complications of pituitary surgery

DI usually presents as a low blood pressure with excessive urine output

  • elevate serum sodium ( >146 mEq/L)
  • elevated serum osmolality
  • possible pre-renal picture with BUN:creatinine ratio (although serum creatinine is unaffected)

SIADH

  • low serum osmolality ( < 270 mOsm/L)
  • high urine osmolality (> 450 mOsm/L)
  • normal to low serum sodium
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30
Q

How do you determine the normal PaO2 of a patient based on their age?

A

PaO2 = 102 - age/3

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31
Q

How does lithium effect ADH release?

A

It inhibits ADH release

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32
Q

What percentage decrease in blood volume must occur to trigger ADH release?

A

5-10% drop

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33
Q

Increases in what plasma levels occur in the body’s response to surgical stress?

A

Increase in plasma levels of:

Cortisol
Renin
ADH
Catecholamines
Endorphines

(Regional anesthesia, however, may block part of the stress response probably by blockade of neural communications from the surgical site)

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34
Q

How much is vital capacity and FRC changed in laparoscopic surgery? How long does it take for levels to return to normal values?

A

Vital capacity and FRC may be reduced by 20-40% postoperatively and may not return to normal values until 2-3 days after surgery.

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35
Q

What are the changes in body composition (muscle and fat) associated with aging?

A
Loss of skeletal muscle
Increase in body fat (especially visceral &amp; intramuscular fat)
Basal metabolism declines
Total body water is reduced
Small decrease in albumin levels
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36
Q

What happens to FRC in the elderly?

A

FRC increases due to the increase in RV (FRC = RV + expiratory reserve volume)

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37
Q

In which direction does the hemoglobin dissociation curve shift with carbon monoxide poisoning?

A

It impairs oxygen unloading to the tissues and shifts the curve to the left.

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38
Q

Describe the acid-base or electrolyte abnormalities found in a patient with uremic syndrome.

Clinical features

A

Uremic syndrome is an extreme from of chronic renal failure, which occurs when GFR decreases to less than 10% of normal.

Clinical features: nausea/vomiting, fatigue, anorexia, weight loss, muscle cramps, pruritis, and change in mental status.

Patients often present with elevated phosphate and magnesium levels as excretion of each decreases with progressive renal failure.

Hyperchloremic metabolic acidosis

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39
Q

Criteria necessary to declare brain death

A

1) Patient must be comatose with neither spontaneous movement nor response to painful stimuli
2) A lack of brain stem activity should be confirmed by assessment of the brain stem reflexes and apnea test

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40
Q

Describe an apnea test

A

An apnea test is used to confirm the lack of brain stem activity

The patient is pre oxygenated with 100% oxygen for 10 minutes, the PaCO2 is confirmed in the normal range, and the patient is administered oxygen for 10 minutes.

The patient is then disconnected from the ventilator and blow-by O2 is administered with a T-piece

After 7-10 mins, a PaCO2 is measured:
if greater than 60 mmHg, and the patient’s abdomen and chest have NOT moved, the apnea test is positive

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41
Q

What are examples of brainstem reflexes?

A
Pupillary response to light
Corneal reflex
Oculocephalic reflex
Oculovestibular reflex
Gag &amp; Cough reflex
Facial motor response
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42
Q

Equation for Mean Arterial Pressure (MAP)

A

MAP = DBP + [1/3(SBP - DBP)

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43
Q

In what population is FRC increased?

A

The elderly

FRC increases with age, but only slightly after 50 years.

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44
Q

What is the leading cause of death in patients with multiple sclerosis (MS)?

A

Bronchial pneumonia due to cranial nerve involvement causing dysphagia

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45
Q

What are some predictive factors of difficult mask ventilation?

A
Obesity
Age > 60 years
Mallampati III or IV view
Snoring
Beard
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46
Q

What is the hallmark finding of COPD based on PFT/Spirometry?

A

Decreases FEV1/FVC ratio

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47
Q

What is Functional Residual Capacity (FRC)?

A

ERV + RV

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48
Q

What Vital Capacity (VC)?

A

IRV + TV + ERV
or
IC + ERV

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49
Q

What PFT increases with COPD? Why?

A

Total lung capacity mainly due to increased Residual Volume

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50
Q

What is DLCO? How is it used?

A

DLCO is the CO Diffusion Capacity

It is an independent predictor for risk of post-op complications and reflects alveolar membrane integrity and pulmonary capillary blood flow

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51
Q

What is a low DLCO indicative of?

A

Low DLCO implies significant emphysema and reduced pulmonary capillary vascular bed

(It can be paradoxically elevated in patients with severe COPD and is indicative of RVH)

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52
Q

How do mediastinal masses effect the flow volume loop?

A

Mediastinal masses are an example of INTRATHORACIC LESIONS which show BLUNTING OF EXHALATION

53
Q

How do extra thoracic lesions effect the flow volume loop?

A

EXTRATHORACIC LESIONS show BLUNTING OF INHALATION

54
Q

How do fixed lesions effect the flow volume loop?

A

Fixed lesions such as tracheal stenosis, show BLUNTING OF BOTH (inhalation and exhalation) limbs

55
Q

What is the formal definition of ARDS?

A

PaO2/FiO2 < 200

56
Q

How will increasing altitude affect the alveolar O2 concentration?

A

It will decrease the alveolar O2 concentration

57
Q

How is the anion gap calculated?

A

Na+ - (HCO3- + Cl-)

Normal is 8-12

58
Q

What are the basic causes for a rightward shift of the oxyhemoglobin dissociation curve?

A

Decreased pH (acidic environment) or Increased H+
Increased temperature
Increased DPG
Increased PCO2

59
Q

Smoking cessation improves what factor immediately (12 hours )?

A

It decreases CO levels

60
Q

What does ventilation do as one moves to more dependent areas of the lung (from West zone 1 to 3)?

A

Ventilation increases

61
Q

Compliance of the alveoli is highest in which West Lung Zone?

A

Zone 3

62
Q

What are the 5 causes of hypoxemia? Which ones demonstrate a normal A-a gradient?

A
Hypoventilation
Low FiO2
Diffusion limitation
Shunt
Ventilation-perfusion mismatch

Normal A-a gradient is shown with hypoventilation and low FiO2 causes

63
Q

Describe uremic syndrome and the electrolyte abnormalities seen in uremic syndrome. What are its clinical features?

A

Uremic syndrome is an extreme form of chronic renal failure, which occurs when GFR < 10% of normal.

Clinical features: N/V, fatigue, anorexia, weight loss, muscle cramps, pruritis, and change in mental status

Electrolyte abnormalities include:
HYPERphosphatemia
HYPERmagnesemia
HYPERkalemia (multifactorial)
HYPERchloremic metabolic acidosis
64
Q

Symptoms of toxic multi nodular goiter

A

Classic triad of goiter, exophthalmos, and pretibial myxedema

Symptoms include:

  • Sinus tachycardia or atrial fibrillation
  • increased sensitivity to catecholamine-induced arryhthmias
  • increased cardiac output and pulse pressure
  • Cardiac failure
65
Q

What are the clinical features of a thyroid storm?

A

Clinical features:

  • Fever
  • Acidosis
  • Tachycardia
  • Arrhythmia
  • HTN or Hypovolemic shock
  • Cardiac failure
  • Agitation
  • Tremor
  • Coma
  • Vomiting
  • ABDOMINAL PAIN
  • Diarrhea
66
Q

How does hypoxemia effect intraocular pressure?

A

Hypoxemia will raise the IOP because the choroidal arterioles respond by vasodilating raising IOP and volume

67
Q

What are the characteristic signs of autonomic hyperreflexia?

A

Hypertension and Bradycardia

68
Q

What are the signs/symptoms of Serotonin Syndrome that differentiate it from Malignant Hyperthermia?

A

Unlike MH, the arterial blood gas analysis, ETCO2 and respiratory rates are often normal when the temperature is elevated.

It is characterized by agitation, confusion, hyperreflexia, hypertension, hyperthermia, and tachycardia.

69
Q

How is Serotonin Syndrome distinguished from Neuroleptic Malignant Syndrome?

A

Neuroleptic Malignant Syndrome has elevated creatinine phosphokinase (CPK) and bradykinesia, absent in Serotonin Syndrome.

70
Q

What is the treatment for Serotonin Syndrome?

A

First, stop the offending drugs, followed by observation for 24hrs, IV fluids, and benzodiazepines to decrease agitation, seizure-like movements, and muscle stiffness.

Cyprohepatdine, which blocks serotonin production, and may be used in treatment.

71
Q

In regards to liver function tests ALT and AST, which one is most sensitive in assessing the degree of liver dysfunction?

A

ALT is more sensitive than AST in assessing the degree of liver dysfunction

72
Q

What is the AST/ALT ratio that indicates alcoholic liver disease?

A

a ratio > 2

73
Q

Conditions associated with a lower DLCO

A

Impaired gas exchange:

COPD
Heart failure
Anemia
Sarcoidosis
Asbestosis
Tuberculosis
74
Q

Conditions that are associated with an increased DLCO

A
Asthma
Polycythemia
L to R intracardiac shunting
Exercise
Pulmonary hemorrhage
75
Q

What electrolyte abnormality increases MAC of volatile anesthetics?

A

HYPERnatremia

76
Q

How to calculate expected baseline PaO2

A

Normal PaO2 = 102 - age/3

77
Q

What are the typical signs/symptoms of Cushing’s syndrome?

A
Volume overload
Hypertension
Glucose intolerance
HYPERglycemia
HYPOkalemic metabolic alkalosis
Central obesity
Moon facies
Buffalo hump
Facial plethora
Skin thinning
Proximal muscle weakness
Osteopenia
78
Q

Chronic bronchitis vs. emphysema

A

Chronic bronchitis is characterized by erythrocytosis and a more elevated Hct compared to emphysema.

  • CB also develops pulmonary HTN leading to cor pulmonale.
  • “Blue bloaters” - copious sputum production, ELEVATED PaCO2, NORMAL elastic recoil, and INCREASED airway resistance

Emphysema patients are referred to as “Pink puffers”

  • chronic coughing with exertion, scant sputum production, NORMAL Hct, NORMAL or DECREASED PaCO2, DECREASED elastic recoil of the lungs, NORMAL to slightly INCREASED airway resistance
  • they develop cor pulmonale late, if at all
79
Q

What would a urinalysis of a pre-renal acute renal injury (ARI) look like? (osmolality, sediment, urine Na+, FENa)

A

Urine osmolality > 500 mOsm/kg
Sediment = hyaline casts (bland)
Urine Na+ < 10 mEq/L
FENa < 1%

80
Q

What are the 3 main divisions of the autonomic nervous system? Describe

A

1) Sympathetic - thoracolumbar, short preganglionic path with synapse near the vertebral bodies
2) Parasympathetic - craniosacral, long pregnanglionic path with synapse near the effector organs
3) Enteric - the gut can function without CNS input

81
Q

What side effects are associated with TURP irrigation solutions? Glycine, Distilled water, Sorbitol, Mannitol, and Lactated Ringers

A

Glycine is responsible for postop visual disturbances (transient post visual syndrome)

Distilled water is profoundly hypotonic and causes HYPOnatremia

Sorbitol cause HYPERglycemia and lactic acidosis

Mannitol causes osmotic diuresis and acute intravascular volume expansion

LR can cause metabolic alkalosis due to the metabolism of lactate to bicarbonate by the liver

82
Q

s/p Parathyroid surgery, when do calcium levels reach a nadir?

A

3-7 days after surgery

83
Q

What drugs should be avoided in patients with Guillan Barre Syndrome?

A

Indirect sympathomimetics due to the up regulation of post-synaptic receptors (an exaggerated response can be elicited)

Succinylcholine

Nondepolarizing muscle relaxants should be used with caution due to hypersensitivity

84
Q

What muscle relaxant should be avoided in patients with Carcinoid tumors?

A

Succinylcholine because it has the propensity to cause a histamine release 2-3 times the ED95 dose

85
Q

What are the diagnostic criteria for Obesity Hypoventilation Syndrome?

A

BMI > 30kg/m^2
Awake arterial hypercapnia (PaCO2 > 45 mmHg)
No other cause for chronic hypoventilation
Abnormal polysomnography findings that include hypoventilation with nocturnal hypercapnia with/without obstructive apnea or hypopnea events

86
Q

What are the risk factors associated with Obesity Hypoventilation Syndrome (OHS)?

A
Male sex
ages 50-70 years
History of chronic fatigue
Mood disorders
Morning and Nocturnal headaches
Dyspnea with minimal exertions 
Hypersomnolence
87
Q

During laryngospasm, what is the afferent limb of the glottic closure reflex?

A

The afferent limb is primarily mediated by the INTERNAL branch of the SLN while the efferent limb is mediated by the RLN

88
Q

What part of the respiratory system does NOT participate in gas exchange?

A

The terminal bronchioles are part of the conducting airways, which begin at the oropharynx and end at the terminal bronchioles. No gas exchanges occur in the conducting airways.

89
Q

What are calcium deposits in the articular cartilage indicative of?

A

Characteristics of PSEUDOgout

[Mainly manifests itself as monarticular and usually involves the knee joints]

90
Q

What is the hallmark finding in gout?

A

Gout is marked by deposition of monosodium rate monohydrate (top) in the joints as a result of chronically elevated uric acid.

91
Q

How does hypothermia increase MAP?

A

Hypothermia causes an increase in SVR by vasoconstriction and also causes an increase in viscosity, which will cause blood pressure to increase

92
Q

How much will pH change for every 10 mmHg change in PaCO2?

A

0.03 units for every 10 mmHg change in PaCO2

93
Q

What is the normal FRC in an adult male?

A

Approximately 2.5 L or 35 mL/kg

94
Q

During acute normovolemic hemodilution, removed blood can be stored at 1-6 degrees Celsius for how long? at room temperature?

A

24 hours at 1-6 degrees Celsius

8 hours at room temperature

95
Q

What is the normal vital capacity in a healthy adult?

A

60-70 mL/kg

96
Q

What is epicritic sensation?

A

It is non-painful sensation such as temperature, touch, pressure, and proprioception

97
Q

What is protopathic sensation?

A

It is painful stimulation and can be further divided into nociceptive and neuropathic.

98
Q

What are some associated pathologies of Systemic Lupus Erythematosus (SLE)?

A
  • atlantoaxial subluxation (9%)
  • chronic pulmonary fibrosis from repeated inflammatory insults results in a restrictive lung pattern
  • tracheal stenosis (~30%)
99
Q

Define hyperpathia

A

Exaggerated pain in response to nociceptive stimuli

100
Q

Define hyperalgesia

A

Increased sensitivity to pain

101
Q

Define Paraesthesia

A

abnormal sensation without an apparent stimulus

102
Q

Define Neuralgia

A

Pain in the distribution of nerve fiber or bundle

103
Q

Define Allodynia

A

Perception of non-noxious stimuli as painful

104
Q

What fruit allergies are associated with a latex allergy?

A

Allergies to bananas and kiwi display a higher propensity to latex allergy

105
Q

What is Fick’s law of diffusion? Describe

A

Diffusion of gas = [A x D x (P1-P2)] / T

where, A = surface area, D = solubility/sq root of molecular weight of gas, P = partial pressure of each side of the tissue, T = tissue surface

Diffusion of a gas across a surface of tissue is increased as the tissue surface area increases.

Diffusion is increased when molecular weight of the gas is decreased because the diffusion constant for the specific gas increases as solubility increases.

Diffusion of a gas increases as the partial pressure difference on each side of the tissue increases, but it decreases when tissue thickness increases.

106
Q

Cushing’s triad

A

Hypertension
Bradycardia
Irregular breathing pattern

107
Q

Laminar flow is affected by what gas characteristic?

A

Gas viscosity

108
Q

Turbulent flow is affected by what gas characteristic?

A

Gas density

atomospheric pressure effects this

109
Q

When does the risk of subglottic tracheal stenosis increase with endotracheal intubation?

A

After the ETT has been in place for 2-3 weeks

110
Q

How do the vocal cords look after bilateral injury to the recurrent laryngeal nerve (RLN) vs. bilateral injury to the vagus nerve?

A

PARTIALLY ADDucted vocal cords occur with bilateral RLN injury due to unopposed crycothyroid muscle.

Bilateral injury to the vagus nerve will eliminate motor innervation to the larynx, causing FULLY ABDUCTED vocal cords.

111
Q

What is the desirable value for maximal oxygen consumption (VO2 max) in pre-op evaluation of a patient for lobectomy?

A

VO2 max > 20 mL/kg/min

112
Q

What anesthetic decreases the incidence of DVTs?

A

Neuraxial techniques desserte the incidence of DVTs by improving microvascular circulation by sympathectomy induced vasodilation

113
Q

What organs make up the vessel-rich group?

A

Brain, liver, kidney, and heart

114
Q

What electrolyte abnormality can cause an increase in serum ionized calcium concentration?

A

Acute HYPOmagnesium will result in an increase in parathyroid hormone which will increase serum iCa

115
Q

What are patients with neurofibromatosis at risk for?

A

Neurofibromatosis (von Recklinghausen’s disease) is also associated with multiple endocrine neoplasia (MEN) 2B which includes medullary carcinoma and pheochromocytoma.

Patients with pheochromocytoma display an exagerrated response to indirect acting vasopressors due to an abnormally large depot of catecholamines

They also have abnormal responses to both depolarizing and nondepolarizing neuromuscular blocking agents

116
Q

How does hypercalcemia effect MAC?

A

Decreases MAC

117
Q

How do Hgb concentration, exercise, PCO2, position, and alveolar fibrosis effect DLCO?

A

1) Hgb concentration is directly proportional to DLCO (decreased Hgb leads to decreased DLCO)
2) Exercise will increase DLCO 2-3 times normal levels
3) PCO2 is directly proportional to DLCO (an increase in PCO2 will lead to increased DLCO)
4) Supine position leads to increased DLCO
5) Alveolar fibrosis (e.g. sarcoidosis, asbestosis, O2 toxicity pulmonary edema) will decrease DLCO

118
Q

What percentage of blood volume must be lost to trigger ADH release?

A

5-10% decrease

119
Q

What is an increase in peak inspiratory pressure (PIP) with no change in plateau pressure indicative of?

A

It signals an increase in airway resistance/inspiratory gas flow rate

  • bronchospasm
  • kinked ETT
  • foreign body aspiration
  • airway compression
  • ETT cuff herniation
120
Q

What is an increase in both peak inspiratory pressure (PIP) and plateau pressure indicative of?

A

It implies an increase in tidal volume or an decrease in pulmonary compliance

  • pulmonary edema
  • pleural effusion
  • ascites
  • peritoneal gas insufflation
  • tension pneumothorax
  • endobronchial intubation
121
Q

What factors predict poor outcomes (desaturation) in one lung ventilation?

A

1) Pre-existing RV/TLC ratio > 50%
2) Right sided thoracotomy
3) Poor PaCO2 on two lung ventilation
4) Surgery in the supine position
5) > 70% of blood flow is to the diseased lung

122
Q

What is a low Reynolds number indicative of?

A

Laminar flow

123
Q

What effect does hyperparthyrodism have on phosphate levels? What occurs?

A

Hyperparathyroidism leads to low phosphate levels, which increases GI absorption of calcium —> stimulating the breakdown of bone —> impairing the uptake of calcium from bone.

124
Q

What is the fastest rate at which a patient with hypernatremia, should be corrected?

A

It should not be decreased faster than 0.5 mEq/L/hr

125
Q

When should initiation of TPN be considered in patients in who enteral feeding is not possible.

A

8 days

noted fewer infections than when initiated earlier

126
Q

What are the 5 classes of pulmonary hypertension as classified by the World Health Organization?

A

Pulmonary HTN is classified by the mechanism of disease:

1) Pulmonary arterial HTN [idiopathic pulmonary HTN]
2) Pulmonary venous HTN [caused by left heart disease]
3) Pulmonary HTN associated with hypoxemia
4) Chronic thromboembolic pulmonary HTN
5) Miscellaneous [pulmonary HTN with unclear and/or multifactorial mechanisms

127
Q

What are the standard phases of immunosuppression?

A

1 )Induction - complete paralysis of the cellular immune system with relatively little regard for medication side effects

2) Maintenance - most regimens consist of steroid plus a calcineurin inhibitor and possibly an anti proliferative agent (e.g. sirolimus)
3) Anti rejection therapy - usually consist of high-dose steroids, or anti-lymphocyte antibodies, or both

128
Q

What is an ABSOLUTE contraindication to ECT?

A

Pheochromocytoma