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ABA Applied Exam > Grab Bag > Flashcards

Grab Bag Flashcards

1
Q

Methymethacrylate

A

Bone cement implantation syndrome:
* hypoxia, hypotension
* supportive tx
* anesthesia cannot prevent
* surgeon can lower wash pressure + drill holes

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2
Q

Equation for PaO2 changes with age

A

PaO2 = 100 - (age/3)

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3
Q

Suspect and TX Bronchospasm

A

Suspect @ elevated Paw + near induction/extubation + hypoxia
auscultate chest - can be wheeze

Tx:
* 100% FiO2
* albuterol puffs
* deepen with volatile > propofol
* small bolus epinephrine
* ketamine
* magnesium
* terbultaine

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4
Q

causes of post-op polyruia

A

central DI
nephrogenic DI
SIADH
osmotic - mannitol, glucose
overhydration

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5
Q

Poor R wave progression

A

LVH
RVH
anterior MI
wnl

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6
Q

Causes of PVC

A

increase catecholamines @ sugery/anxiety
∆ lytes : hypoK, hypoMg, hyperC

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7
Q

Normal CBF
Ischemic CBF
death CBF

A

50-55 cc/min/100g
18-20 cc/min/100g
8-10 cc/min/100g

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8
Q

A s/e terbutaline

A

hypotension
palpitations
CP
pulmonary edema
hypokalemia
hyperglycemia

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9
Q

Treat hemophilia A intraop coagulopathy

A

(-) VIII
can give VIII but quickly develop abx and become refractory&raquo_space; treat with PCC (has proteases that will breakdown abx, short life) and VIIa (stabilizes downstream coag pathways)

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10
Q

Oligura ddx PRE/INTRA/POST

A

factor→pre/intra/post:
Usmo→ >500/ <350/∆
UNa→ <10/>10/∆
FeNA → <1/>2%

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11
Q

FeNa formula

A

FeNa = (Una x Pcr) / (UCr x Pna)

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12
Q

lyte ∆ at CRF

A

HYPERK, HYPERPO4, HYPERMg
HYPER uric acid, HYPERlipid, HYPERsulphate

hypoNa, hypoCa, hypoalbimin

AG metabolic acidosis

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13
Q

Neuraxial and LMWH/enoxaparin/lovenox ppx qd

A

HOLD BEFORE NEEDLE: 12 hours
RESTART AFTER NEEDLE: 12 hours
HOLD BEFORE CATH OUT: 12 hours
RESTART AFTER CATH OUT: 4 hours

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14
Q

Neuraxial and LMWH/enoxaparin/lovenox ppx BID

A

HOLD BEFORE NEEDLE: 12 hours
RESTART AFTER NEEDLE: 12 hours
HOLD BEFORE CATH OUT: remove before starting, do not use this does while catheter in. SPINAL HEMATOMA
RESTART AFTER CATH OUT: 4 hours

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15
Q

Neuraxial and LMWH/enoxaparin/lovenox therapeutic

A

dose is 1 mg/kg q12 OR 1.5 mg/kg daily
HOLD BEFORE NEEDLE: 24 hours
RESTART AFTER NEEDLE: 24 after non high bleeding risk surgery OR 72 hours after high bleeding risk surgery
HOLD BEFORE CATH OUT: remove before starting, do not dose this way when catheter in SPINAL HEMATOMA
RESTART AFTER CATH OUT: 4 hours

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16
Q

Neuraxial and SQ heparin ppx BID or TID

A

HOLD BEFORE NEEDLE: 4-6 hours OR check coags
RESTART AFTER NEEDLE: immediately
HOLD BEFORE CATH OUT: 4-6 hours
RESTART AFTER CATH OUT: immediately

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17
Q

Neuraxial and SQ heparin ppx high dose BID or TID

A

HOLD BEFORE NEEDLE: 12 hours and coags
RESTART AFTER NEEDLE: unknown
HOLD BEFORE CATH OUT: unknown
RESTART AFTER CATH OUT: immediately

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18
Q

Neuraxial and SQ heparin therapeutic

A

HOLD BEFORE NEEDLE: 24 hours and coags
RESTART AFTER NEEDLE: not recc with catheter in place
HOLD BEFORE CATH OUT: not recc with catheter in palce
RESTART AFTER CATH OUT: immediately

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19
Q

Neuraxial and bypass heparin

A

HOLD BEFORE NEEDLE: avoid
RESTART AFTER NEEDLE: 60 minutes
HOLD BEFORE CATH OUT: after normal coagulation restored
RESTART AFTER CATH OUT: n/a

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20
Q

Neuraxial and IV heparin

A

HOLD BEFORE NEEDLE: 4-6 hours and normal coags
RESTART AFTER NEEDLE: 1 hour
HOLD BEFORE CATH OUT: 4-6 hours and normal coags
RESTART AFTER CATH OUT: 1 hour

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21
Q

Neuraxial level @ C/S

A

T6 hyperbaric

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22
Q

Neuraxial level @ cervical cerclage

A

T10 hyperbaric

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23
Q

Neuraxial level @ hips

A

> T12 isobaric

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24
Q

Neuraxial level @ knees

A

> T12 isobaric

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25
Q

Neuraxial level @ TURP

A

> T10 of iso or hyperbaric

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26
Q

Treat unstable narrow regular tachycardia

A

SYNC CARDIOVERT 50-100 J

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27
Q

Treat unstable narrow irregular tachycardia

A

SYNC CARDIOVERT 120-200 J

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28
Q

Treat unstable wide regular tachycardia

A

SYNCO 100 J

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29
Q

Treat unstable wide irregular tachycardia

A

DEFIB 360 J (polymorphic VT)
Mg at torsades

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30
Q

Test dose composition

A

1.5% lidocaine with 1:200 000 epinephrine

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31
Q

Ekg leads to use intraop

A

V5 - 75%
V5 + V4 - 90%
V5 + V4 + II - 96%
change of detecting ischaemia

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32
Q

ddx Myasthenic crisis from cholinergic crisis

A

use edrophonium or tensilon test
MG > weakness will worsen
CC > weakness will improve

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33
Q

Treat cholinergic crisis

A

supportive w/ possible intubation
d/c anticholinesterase therapy
begin anticholinergics
IVIG

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34
Q

Treat myasthenic crisis

A

supportive
IVIG
plasmaphoresis

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35
Q

RF in MG for postop mechnical ventilation

A
  • duration of disease > 6 years
  • pyridostigmine > 750 mg/day (usually q6h regiment)
  • concomitant pulmonary disease
  • PIP < -25 cmH2O
  • VC < 40 /kg
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36
Q

Extubation criteria: simplified

A
  • hemodynamically stable
  • adequately reversed
  • awake and alert
  • spontaneously ventilating
  • VT 6-9 cc/kg
  • RR 12-20 with ETCO2 35-40 mmHg
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37
Q

Extubation criteria: detailed

A
  • VC > 15 cc/kg
  • pH > 7.3
  • PaO2 > 60 mmHg on FiO2 > 50%
  • Max NIF > -20
  • RR < 30
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38
Q

Treat venous air embolism

A

Saline onto surgical field
Bone was onto exposed surfaces
aspirate from CVL
gentle compression of IVC
supportive

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39
Q

HSV and neuraxial in pregnancy?

A

Primary and not treated > contraindicated, possible viremia
Secondary and treated > indicated, low risk viremia

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40
Q

MH vrs thyroid storm

A

MH: hyperK, rigid, increased CK, lactic acidosis, intraop
Thyroid storm: hypoK, not rigid, no CK, no lactate, postop

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41
Q

Treat MH

A

dantrolene 2.5 mg/kg
nondepol will not cause paralysis

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42
Q

Treat Thyroid storm

A

PTU
beta blockers
iodinated contrast
steroids
acetaminophen
reserpine to deplete

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43
Q

Treat neuroleptic syndrome

A

bromocriptine
+/- dantrolene
stop haldol
nondepol MB will result in flaccid paralysis

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44
Q

Treat serotonin syndrome

A

cyproheptadine
stop serotonergic meds

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45
Q

drugs dosed by IBW

A

nondepol NB

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46
Q

drugs dosed by TBW

A

sux
opioids
propofol gtt

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47
Q

drugs dosed by LBW

A

propofol induction

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48
Q

TX TURP syndrome

A

stop irrigation
fluid restriction if Na >120 and symptomatic
hypertonic saline if Na <120
intubated
loop diuretics
benzos for seizures

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49
Q

Nitroprusside toxicity metabolits

A

cyanomethemoglobin
thiocyanate
cyanide toxicity > MvO2 increases

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50
Q

Tx Nitroprusside toxicity

A

stop nitroprusside
sodium thiosulfate
inhaled amyl nitrates
hydroxycobalamine

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51
Q

consequences of hyperglycemia

A
  • decreased immune function
  • increased oxidative stress
  • endothelial dyd
  • increased inflammatory factors
  • increased procoagulant state
  • fluid shifts
  • electrolyte ∆
    @ surgery
  • decreased wound healing
  • increased infections
  • delayed recovery
  • end organ failure @ heart, brain, kidney
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52
Q

Sx of hypoglycemia under GA

A

cant see confusion
maybe diaphoresis

Suspect if concern for light anesthesia = SNS activation

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53
Q

causes of intraoperative hypoK

A

@ high flow urine (osmotic - mannitol, hyperglycemia OR overhydration, DI, SIADH)
@ excess mineralocorticolides
@ cisplastin/aminoglycosides
@ diuretics
@ vomiting
@ diarrhea
@ alkalemia

54
Q

Avoid @ IOP

A

sux
nitrous oxide
ketamine
retrobulbar block
cough
buck

55
Q

:) @ IOP

A

decreased IOP
@ volatiles
@ narcotics
@ barbiturates
@ lidocaine
@ nondepolMB

56
Q

EKG changes from hypoK

A

flat/inverted T waves
U waves
ST depressions

57
Q

treat hypoK

A

replete Mg
replete K
correct alkalemia
stop over diuresis
stop offending drugs

58
Q

A s/e of hypoK

A

cardiac hyperrepolarization and excitability
muscle weakness
digoxin toxicity

59
Q

Max FiO2 on NC

A

RA ie 21% + 2-3% for each L
max 6 L
max FiO2 35%

60
Q

Max FiO2 on FM

A

RA + 2-3% for each L
max 10 L
max FiO2 45%

61
Q

Drugs to avoid at Pheochromocytoma

A

avoid tumour stimulation: no sux
avoid SNS stimulation: no ketamine, ephedrine, atropine
avoid histamine release: no sux, morphine, atracurium, cisatracurium
specific to pheo: no metoclopramide, droperidol

62
Q

weird random drugs to avoid in pheochromocytoma

A

metoclopramide, droperidol

63
Q

normal PaO2 on RA

A

80-100
PaO2 = 100 - (age/3)

64
Q

SSEP evaluation

A
  • keep anesthesia stabilized
  • decreased amplitude, increased latency > talk to surgeon
65
Q

Describe burst suppression

A

periods of isoelectricity with slow high voltage wave oscillations

66
Q

Why burst suppression

A

neuroprotective
thought to reduce ICP via reduciton of CMRO2 and CBF

67
Q

Treatment of refractory ICP

A

barbiturates
decompressive craniotomy

68
Q

cisatracurium intubating dose

A

0.15 mg/kg
takes 2 mins onset
lasts 60 mins

69
Q

Triad for CSWS

A

hyponatremia
volume contration
low to normal urine osm

70
Q

Triad for SIAD

A

hyponatremia
hyperosmolar urine
eu or hypervolemic

71
Q

Respiratory changes in pregnancy

A
  • mucous capillary engorgement
  • MMP 1+ during labour
  • aspiration risk
  • decreased FRC, ERV
  • unchanged TLC bc chest expands
  • diaphragm movement not restricted
  • compression by fetus
  • increased metabolic demand and increased minute ventilation
  • rapid onset with volaties

(avoid volatiles after birth > relaxation)

72
Q

EKG at hyperK

A

peaked T waves
prolonged PR
flat wave
widened QRS

73
Q

K for intervention

A

EKG changes
OR
>6
first EKG usually at 6.5

74
Q

Result of alkalinization fo local anesthetics

A

less cations
lipid soluble
can cross membrane easier
more rapid onset

75
Q

name of syndrome in paralyzed patients that you always forget

A

autonomic hyperreflexia = loss of descending inhibitory pathways = uninhibited spinal cord reflexes with substantial increased in BP above level of lesions, overzealous vagal response - bradycardia, heart block vasodilation

76
Q

Level for at risk of autonomic hyperreflexia

A

T7

77
Q

Describe response to pain in a paraplyzed patient at level T7 or higher

A

spinal relexes unchecked by descending inhibitory pathways

Hypertension then exagerrated vagal response - brady, heart block, vasodilation

78
Q

Celiac plexus block indicatiosn

A

SNS drive pain T5-T12, pancreatic cancer

79
Q

S/e celiac plexus block

A

most common - orthostatic hypotension
second most common - diarrhea
LAST
intrathecal
perforation Ao, IVC, viscera
PTX, chylothorax
paraplegia

80
Q

postpone surgery for URTI?

A

postponing for 2 - 3 weeks is reasonable; can have hyperreactivity for up to 8 and icnreased respriatory complications

81
Q

Preop meds for COPD

A

bronchodilators
anticholinergics
preop low dose steroids

82
Q

Steroids periop?

A

systemic steroids for more than 2 weeks in last six months

induction: 100 mg hydrocortisone
postop: 100 mg q8h for 48 hours.

83
Q

Principles of anesthetic management for asthmatic patient x3

A

Block airway reflexes before DL and intubation

Relax airway smooth uscle

prevent release of biochemical mediators

84
Q

Induce an asthmatic

A

albuterol
induce with 2.5 mg propofol
oxygen and sevo to deep (iso and des more pungent)
lidocaine

OR

LMA

85
Q

what NMB to use in asthmatics?

A

avoid those that cause histamine release: pancuronium, atracurium, sux, mivacurium

USE vec, roc, cisatraciurium

86
Q

ventilatory mode in COPD

A

PC > can achieve tidal volumes at lower PIP
increased expiratory time on I:E
may need increased minute ventilation to keep normocarbia

PEEP is controversial > can reduce work of breathing, extrinsic peep shouldnt be more than intrinsic peep, watch out for VR

watch out for autoPEEP

87
Q

first line treatment for bronchospasm

A

100% FiO2 and deepen anesthesia b/c most usually due to light anesthesia

88
Q

pain control to avoi in asthmatics

A

nsaids
morphine (histamine)

89
Q

supplemental oxygen and COPD postop

A

tend to take smaller tial volumes.l

90
Q

signs and symptoms of hepatopulmonary syndrome

A

platypnea/dyspnea in upright position
hypoxia PaO2 < 70 on RA
fatigue
digital clubbing
spider angiomata
orthodeoxia - desat upright

91
Q

cause of hepatorenal syndrome

A

functional renal vasoconstriction 2/2 splanchnic vasodilation

92
Q

diagnosis fo hepatorenal syndrome

A
  • cirrhosis with ascites
  • serum Cr > 1.5
  • no improvement of Cr with 2 days fo diuretic, volume expansion with albumin
  • absence of shock
  • no nephrotoxic drugs
  • no parenchymal kidney disease
  • doestn respond to fluid bolus like prerenal
93
Q

TEST DOSE

A

3 cc 1.5 % lidocaine with 1:200 000 epinephrine

94
Q

Dose for labour epidural

A

bupi 0.0625%+ 0.1% fent at rate of 6 cc/hour with bolus 2-3 cc q20 mins

95
Q

treat diabetes insipidus

A

maintainence fluids with D51/2NS and monitor gluc and K
crystalloid for 2/3 last hours UOP
If > 350-400 cc/ hour&raquo_space; DDAVP

96
Q

Treat MH

A

stop triggers
increased oxygen flow to 10-15 ppm and FiO2 100

DANTROLENE 2.5 mg/kg q5 min until ETCO2 decreased or temp stops rising

treat hyperK

be prepared to treat arrhythmias

cool

maintain UOP 1-2 cc/kg

ICU for 24 hours with dantrolene 0.25 mg/kg/h and bolus q4-6 hours

97
Q

hypothyroidism consequences

A

hyponatremia
hypoglycemia
impaired drug metabolism

98
Q

clonidine preop

A

maintain > can have rebound hypertension if stopped

99
Q

limitations of PULSE OX accuracy

A

1) no pulse present; low perfusion pressure (hypotension, hypothermia, hypovolemia)
2) hemoglobin variants/dyes
3) severe anemia < 3-4
4) venous pulsation ie RHF and TR

100
Q

intrathecal morphine dose for c/s

A

morphine 100 mcg

101
Q

ex: TCAs

A

amitriptyline
nortriptyline

102
Q

ex: SNRIs

A

duloxetine
fluoxtine

103
Q

Ex: Anticonvulsants

A

gabapentin
pregablin

104
Q

Treat chronic radicular back pain

A

PT
opiods and NSAIDS
epidural steroid injections

105
Q

Steroid used for chronic pain epidural steroid injections

A

methylprednisilone

106
Q

treat facet syndrome

A

median branch blocks
(also dxtic)

107
Q

treat myofascial pain syndrome

A

massage
needling dry or LA

108
Q

treat fibromyalgia

A

SNRI
anticonvulsants
TCAs
support, educate, exercise, CBT

109
Q

treat diabetic neuropathy

A

glucose control
anticonvulsants
TCA > SNRI

110
Q

Treat CRPS

A

SNS nerve blocks
PT
medication of all sorts

111
Q

Treat phantom pain

A

TENS
spinal cord stimulator
biofeedback

112
Q

Treat cancer pain

A

appropriate tumour specific neoplastic therapy
WHO ladder
opioids, TCA, SNRI, anticonvulsants, NSAIDs, corticosteroids, oral locals, topicals
interventional (celiac, superior hypogastric, ganglion impar)
behaviour and pscyh
hospice

113
Q

When to use spc stimulator

A

intractabel pain of trunks or limbs that fail other management
@ post laminectomy syndrome
@ CRPS
@ neuropathic pain syndrome
@ angina
@ chronic critical limb ischaemia and pain

114
Q

when to use intrathecal drug delivery

A

chronic pain w/o response to high dose or unacceptable s/e

115
Q

PAC indications for the boards

A

measuring PCWP
CO measurement
mixed venous oxygen saturation measurement
pHTN
pacing

116
Q

Bucking on the tube

A

light sedation
pain control inadequate
non paralyzed

117
Q

treat afib

A

amiodarone
beta block
CCB
digoxin
electricty

118
Q

assess hypoV in infants

A

number of diapers
PO intake
tachycardia
cap refil
fontanelles
cold skin
mottling
cyanosis
altered consciousness
HYPOTENSION IS OMINOUS (35% volume lost before this occurs)

119
Q

risk factors for airway hyperreactivity with URTIS peds

A

< 1 year old
smoker in household
bronchopulmonary dysplasia
asthma

120
Q

epinephrine dose arrest IV peds

A

0.01-0.03 mg/kg

121
Q

epinephrine dose arrest ETT peds

A

0.1 mg/kg

122
Q

Atropine dose IV peds

A

0.01-0.02 mg/kg

123
Q

atropine dose ETT peds

A

0.3 mg/kg

124
Q

adenosine peds dose

A

0.1 mg/kg
max 6 mg

125
Q

defibrillation peds dose

A

2-4 Jkg

126
Q

APGAR score

A

A - appearance/cyanotic + fingers and toes blue only + pink all over
P - pulse/ none + < 100 + 100-140
G - grimace - none / weak / strong
A - activity - floppy / some flexion / resists extension
R - respirations / none + slow and irregular / strong cry

127
Q

associated with TEF

A

VACTERL
veretbral
anal atresia
cardiac
TEF
renal and radial
limb
20% have cardiac

128
Q

goal for oxygenation in preterm infant

A

avoid retionopathy
PaO2 50-80 mmHg + SaO2 87-94%

129
Q

cobb angle values with implications

A

SCOLIOSIS
> 10 abnormal
> 45-50 surgery
> 60-65 pulmonary dyd
> 70 pHTN at exercise
> 110 pHTN at rest

130
Q

CO2 laser

A

corneal injury

ABA Applied Exam (5 decks)

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