General OA Questions

Question 1

When does Acute hemolytic reaction occur? And is typically due to what? Symptoms? Which test confirms it, and how? What’s haptoglobin and indirect bilirubin? Treatment?

Answer 1

When DONOR cells are rapidly destroyed by host antibodies, and are typically due to ABO incompatibility. Symptoms-chills, fever, flank and chest pain, but under GA-hypotension, bleeding diathesis, and hemoglobinuria. Direct Coombs test confirms it, and it confirms cells coated with antibody or complement. Haptogloin and INdirect bilirubin would be increased. Treatment-supportive and correct DIC if present.

Question 2

What’s an Indirect Coombs year? Who gets it?

Answer 2

It detects antibodies against RBCs that are present (unbound) in the patient’s serum. Used in pre Ayala testing if pregnant women and prior to a blood transfusion

Question 3

What is a mandatory thing patients have to have before discharge from an Amb-Surg center?

Answer 3

An adult escort

Question 4

Patient is cachectic and malnourished. What’s a drug that might have increased length of action?

Answer 4

Succinylcholine. Ppl who are malnourished can have acquired pseudochokinesterase deficiency, increasing tune of Sux and ester local anesthetics. Chronic liver and renal disease, malignancy, burns, extremes of age and pregnancy can cause this also

Question 5

Anesthesia equipment needs to be how many Gauss’ away from the MRI machine?

Answer 5

Greater than 5 Gauss

Question 6

Indications for Arterial Line

Answer 6

Labile blood pressure
Anticipation of haemodynamic instability
Titration of vasoactive drugs
Frequent blood sampling
Morbid obesity (unable to fit an appropriately sized NIBP cuff)

Question 7

Characteristics of patients with Obesity hypoventilation syndrome

Answer 7

BMI >39, CO2>45, Hypoxemia (PaO2 less than 70), and pulmonary hypertension. Treatment can be cpap, bipp

Question 8

Metyrosine. What does it do, and when is it given?

Answer 8

Given in pheo’s, it prevents conversion of tyrosine to dopa which

Question 9

How is remi metabolized?

Answer 9

Non-specific esterases. It agonizes mu. Be careful in non-intimated patients because it causes serious respiratory depression.

Question 10

T/F it’s common for cirrhosis patients to have hypoxemia

Answer 10

True. Due to Cephalad movement of the diaphragm

Question 11

What is hepatopulmonary syndrome?

Answer 11

Hepatic dysfunction, hypoxemia ( PaO2 <70% on FiO2 is .21), and extreme vasodilation in the form of intrapulnonaey vascular silatations

Question 12

What is Portopulmonary HTN?

Answer 12

Pul arterial hypertension complicating portal HTN in patients with liver disease. Caused by vasoconstriction, pulmonary vascular hyperteophy, and or thrombotic processes. Results in hypoxemia woh signs of right heart failure.

Question 13

What is a Porto-systemic/Porto-Heptic shunt?

Answer 13

A venous bypass of the liver’s portal blood that occurs in patients with portal HTN. It does NOT cause hypoxemia

Question 14

If you increase PaCO2 by hypoventikation, what happens to the PaO2? Can you manipulate his with FiO2?

Answer 14

It decreases. It can be manipulated by increasing the FiO2 or keeping it steady in the event that you would expect hyooventiktion (administration of opioids)

Question 15

Neurological changes with reverse t Berg?

Answer 15

Reduced cerebral perfusion pressure, decreased cerebral blood flow

Question 16

NiTRIC oxide-works how? What does it do? How can it become toxic-who is more at risk for toxicity?

Answer 16

It is a potent arterial vasodilator, so it decreases pulmonary artery pressure. It diffuses from the alveoli into the smooth muscle cells of the circulation and stimulates guanylate Cyclase to produce cGMP which then causes pulmonary vasodilation. Toxicity results from the formation of nitric dioxide (can cause pulmonary edema) and methemoglobinemia (tissue hypoxia-newborns more affected)

Question 17

With dehydration, what do you expect the urine sodium to be and why? What about fractional excretion of sodium?

Answer 17

Less than 20 because it is reabaorbed in the thick ascending limb and in the proximal tubule.