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HAExamIII Flashcards

1
Q

Which fluid space is more immediately altered by the kidneys?

A

ECF

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2
Q

What composes the ECF? What’s its volume?

A

ISF and Plasma = <1/2 volume of TBW

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3
Q

________ is mainly mediated by osmolality-sensors in the anterior hypothalamus

A

Osmolar Homeostasis

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4
Q

What does osmolar homeostasis consist of?

A
  1. Stimulate thirst
  2. Cause pituitary to release ADH
  3. Cardiac atria releases ANP
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5
Q

What mediates volume homeostasis? How?

A

Juxtaglomerular apparatus; Decreased volume at JGA triggers RAAS to stimulate Na+ H2 reabsorption

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6
Q

What’s the underlying cause of hyponatremia?

A

Hypervolemia

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7
Q

What levels of Na+ needs to be corrected before to an elective cases?

A

≤125 mEq or ≥ 155 mEq

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8
Q

What are 4 causes different causes of hypovolemia?

A
  1. Diuretics
  2. GI Loss (vomitting/diarrhea)
  3. Burns
  4. Truama
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9
Q

What are some causes of euvolemia?

A
  1. Glucocorticoid deficiency
  2. Hypothyroidism
  3. High sympathetic drive
  4. Drugs
  5. SIADH
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10
Q

What are some causes of hypervolemia?

A
  1. ARF
  2. HF
  3. Hyperaldosteronism
  4. Cushings
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11
Q

Serum Na+: <120 mEq/L

A
  1. Restlessness
  2. Lethargy
  3. Seizures
  4. Brain-stem hernation
  5. Respiratory arrest
  6. Death
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12
Q

Serum Na+: 120-130 mEq/L

A
  1. Malaise
  2. Unsteadiness
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13
Q

Serum Na+: 130-135 mEq/L

A

Depressed reflexes

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14
Q

How fast can we run hypertonic saline (3% NaCl)?

A

80 mL/hr

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15
Q

What can cause osmotic demyelination syndrome?

A

> 6 mEq/L of Na+ in 24 hours

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16
Q

What can cause hypernatremia?

A
  1. Excessive evaporation
  2. DI
  3. Excessive NaHCO3
  4. GI Losses
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17
Q

What should be the Na+ reduction rate?

A

≤ 0.5 mmol/L/hr or ≤ 10 mmol/L per day to avoid cerebral edema, seizures, and neurological damage

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18
Q

What is a major ICF cation?

A

K+

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19
Q

Serum K+ reflects?

A

Transmembrane K+ regulation

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20
Q

What does aldosterone do?

A

Causes the distal nephron to secrete K+ and reabsorb Na+

Aldosterone inversely effects K+

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21
Q

What are some common causes of hypokalemia?

A
  1. Renal Loss - diuretics, hyperaldosteronism
  2. GI loss - V/D, malabsortion
  3. Transcellular shift
  4. Low PO intake
  5. DKA
  6. Excessive black licorice
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22
Q

What causes an intracellular shift of K+?

A
  1. Alkalosis
  2. Beta Agonists
  3. Insulin
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23
Q

For every 10 mEq IV K+, serum K+ increases by how much?

A

0.1 mmol/L

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24
Q

What can cause hyperkalemia?

A
  1. Renal failure
  2. Hypoaldosteronism
  3. Depolarizing NMB (Succs)
  4. Acidosis
  5. Cell death (trauma)
  6. Drugs that inhibit RAAS
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25
Q

What is the EKG progression of hyperkalemia?

A
  1. Peaked T wave
  2. P wave disappearance
  3. Prolonged QRS complex
  4. Sine wives
  5. Asystole
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26
Q

What are some of the primary treatments for hyperkalemia?

A
  1. Dialysis
  2. Ca2+
  3. Hyperventilation
  4. Insulin + Glucose (10-20minutes)
  5. Bicarb
  6. Kayexalate (hrs to days)
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27
Q

How much does hyperventilating improve pH? K+?

A

Increases pH by 0.1 for every 0.4-1.5 mmol/L decrease in K+

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28
Q

How much Ca2+ is in the ECF? bone?

A

1%; 99%

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29
Q

What is ionized Ca2+? Why is this important?

A

Ca2+ is not protein bound. Only non-protein bound Ca2+ is physiologically active

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30
Q

What is a normal iCa2+?

A

1.2-1.38 mmol/L

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31
Q

What two things affect iCa2+?

A
  1. Albumin level
  2. pH
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32
Q

What is the effect of increased pH/alkalosis on Ca2+?

A

Increases Ca2+ binding to albumin

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33
Q

What do we need to avoid with hyperkalemia?

A
  1. Succs
  2. Hypoventilation
  3. LR & K+ containing IV fluids
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34
Q

What does PTH do?

A

Increases GI absorption, renal reabsorption of Ca2+ and Ca2+ resorption from the bone.

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35
Q

What does calcitonin do?

A

promotes Ca2+ reabsorption (decreases plasma Ca2+) into the bone

Calcitonin inhibits bone resorption to decreases serum Ca2+

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36
Q

What can cause hypocalcemia?

A
  1. Complication of thyroid/PT surgery
  2. Mg2+deficiency
  3. Low vitamin D
  4. Decreased PTH
  5. Renal failure
  6. Massive blood transfusion
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37
Q

What can cause hypercalcemia?

A

Hyper-parathyroid or cancer

Less common causes include:
1. Vitamin D intoxication
2. Milk-alkali syndrome
3. Granulomatous diseases (sarcoidosis)

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38
Q

When should we check our iCa2+?

A

After 4+ units of PRBCs

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39
Q

What is milk-alkali syndrome?

A

Excessive GI Ca2+ absorption

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40
Q

What can be caused by chronic hypercalcemia?

A
  1. Hypercalciuria
  2. Nephrolithiasis
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41
Q

What is the major complication of post-parathyroidectomy?

A

Hypocalcemia induced laryngospasm

Life threatening

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42
Q

What is the serum Ca2+ for hyperparathyroid? Cancer?

A

Hyperparathyroid: < 11
Cancer: >13

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43
Q

What electrolyte is necessary for PTH production?

A

Mg2+

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44
Q

What are the causes of hypomagnesia?

A
  1. Low dietary intake or absorption
  2. Renal wasting
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45
Q

What causes hypermagnesemia?

A

Overtreatment pre-eclampsia/eclampsia

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46
Q

Serum Magnesium: 4-5 mEq/L

A

Lethargy, N/V, flushing

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47
Q

Serum Magnesium: > 6 mEq/L

A

HoTN, decreased DTR

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48
Q

Serum Magnesium: >10 mEq/L

A

Paralysis
Apnea
Heart blocks
Cardiac arrest

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49
Q

Where are the kidneys located?

A

Retroperitoneal between T-12 and L-4

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50
Q

How much of the total CO do the kidneys recieve?

A

20%; 1-1.25 L/min

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51
Q

What part of the kidney is particularly vulnerable for developing necrosis in response to hypotension?

A

Loop of Henle

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52
Q

What does the RAAS do in simple terms?

A

Increases serum Na+ and H2O reabsorption

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53
Q

What hormones do the kidneys make?

A

Renin
Erythropoietin
Calcitriol
Prostaglandins

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54
Q

What are the kidneys functions according to HA class?

A
  1. Regulate the volume, composition, and osmolarity of ECF
  2. Regulate BP
  3. Maintain acid/base balance
  4. Excrete toxins/metabolites
  5. Produce hormones
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55
Q

What is a normal GFR?

A

125-140 mL/min; best measure of renal function over time

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56
Q

What’s important to know about measuring GFR?

A
  1. Best measure of renal function over time
  2. Heavily influced by hydration status
  3. GFR better for trending
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57
Q

What’s a normal creatinine clearance?

A

110-140 mL/min

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58
Q

What’s important to know about creatinine clearance?

A

Most reliable measure of GFR

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59
Q

What is the normal serum creatinine?

A

0.6-1.3 mg/dL

Correlates with muscle mass

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60
Q

What is good about serum creatinine?

A
  1. Inversely related to GFR
  2. Better for detecting an acute change in kidney function
  3. Can be influced by high protein diet, supplements, and muscle breakdown
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61
Q

What is a normal BUN?

A

10-20 mg/dL

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62
Q

What is a normal BUN:Creatinine ratio? What is this a measurement of?

A

10:1; hydration status

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63
Q
A
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64
Q

What is normal proteinuria? Abnormal?

A

< 150 mg/dL; > 500 mg/dL

> 500 mg/dL suggests glomerular injury or UTI

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65
Q

What is a normal specific gravity?

A

1.001-1035

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66
Q

What is considered to be a late sign of volume loss?

A

Drop in UOP

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67
Q

What volume is considered to be oliguria?

A

< 500 mL in 24 hours

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68
Q

What collapse indicates a fluid deficit?

A

IVC collapse > 50%

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69
Q

What is considered powerful stimuli for renal vasoconstriction?

A

LAP, PCWP

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70
Q

A build up nitrogenous products such as urea and creatinine

A

Azotemia

Hallmark of AKI

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71
Q

What causes prerenal azotemia? (long list)

A
  1. Hemorrhage
  2. GI fluid loss
  3. Trauma
  4. Surgery
  5. Burns
  6. Shock
  7. Sepsis
  8. Aortic Clamping
  9. Thromboembolism

First 5 most important

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72
Q

What causes (intra)renal azotemia?

A
  1. Acute glomerulonephritis
  2. Interstitial nephritis
  3. Vasculitis
  4. Contrast dye
  5. ATN
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73
Q

What causes post renal azotemia?

A
  1. Nephrolithiasis
  2. BPH
  3. Clot retention
  4. Bladder carcinoma
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74
Q

Primary risk factors of AKI

A
  1. Pre-existing renal disease
  2. Age
  3. CHF
  4. Diabetes
  5. PVD
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75
Q

Azotemia: Pre-renal

A
  1. Decreased renal perfusion
  2. Most common form
  3. Reversible
  4. Tx: Restore RBF
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76
Q

Azotemia: (Intra)renal

A
  1. Nephron injury
  2. Intrinsic renal disease
  3. potentially reversible
  4. decreased GFR is a late sign
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77
Q

Azotemia: Post Renal

A
  1. Outflow obstruction
  2. Easiest to treat
  3. Tx: Remove obstruction
  4. Hydronephrosis (increased nephron hydrostatic pressure)
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78
Q

BUN:Cr ratio pre-renal azotemia

A

> 20:1

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79
Q

BUN:Cr ratio intra-renal azotemia

A

< 15:1

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80
Q

Vasopressin preferentially constricts what? Why is this important?

A

Efferent arteriole; better than alpha agonists for maintaining RBF

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81
Q

In anesthesia preparation for the AKI patient, what recent lab is the most important?

A

K+

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82
Q

What are the two leading causes of CKD?

A
  1. Diabetes
  2. Hypertension
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83
Q

How much does GFR decrease per decade?

A

10 mL per decade starting from age 20

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84
Q

What is first line treatment for hypertension in the CKD patient?

A

Thiazide diuretics

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85
Q

What medications are held on the day of surgery to decrease the risk of profound hypotension?

A

ACE-I/ARBs

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86
Q

What is considered to be dyslipidemia?

A

Triglycerides > 500
LDL > 100

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87
Q

What is the target Hgb for anemic patients?

A

10

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88
Q

Which populations are high risk for silent MI?

A
  1. Women
  2. Diabetics
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89
Q

What is the peak and duration of desmopressin (DDAVP)?

A

Peak: 2-4 hours
Duration: 6-8 hours

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90
Q

Which NMB is best for kidney patients?
What reversal is NOT recommended for kidney patients?

A

Nimbex (Cisatracurium); Sugammadex

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91
Q

What does the patient’s K+ level have to be prior to surgery?

A

< 5.5 mEq/L

for elective surgery

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92
Q

Functions of the liver

Long list, just read through them

A
  1. Synthesizes glucose via gluconeogensis
  2. Stores excess glucose as glycogen
  3. Synthesizes cholesterol and proteins into hormones and vitamins
  4. Metabolizes fats, proteins, carbs to generate NRG
  5. Detoxifies blood
  6. Metabolizes drugs via CYP450 and other pathways
  7. Involved in the acute-phase of immune support
  8. Processes Hgb and stores iron
  9. Synthesizes coagulation factors
  10. Aids in volume control as a blood reservoir
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93
Q

What are the three hepatic veins? Where do they empty?

A

Right, middle, left; IVC

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94
Q

Where does bile enter the duodenum?

A

Ampulla of Vater

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95
Q

s

How much CO does the liver receive?

A

25%; 1.25-1.5 L/min

Highest proportion out of all the organs

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96
Q

How is hepatic blood flow split up? O2 delivery?

A

Portal vein = 75% of HBF
Hepatic artery = 25% of HBF
50:50 O2 delivery

97
Q

What are the coagulation factors that the liver does NOT synthesize?

A

III, IV, VIII, vWF

98
Q

What is portal HTN?

A

Hepatic arterial blood flow inversely related to portal venous blood flow

99
Q

What results from increased portal venous pressure?

A

esophageal and gastic varices

100
Q

HVPG: 1-5 mmHg

Hepatic Venous Pressure Gradient

A

Normal portal venous pressure

101
Q

HVPG: >10 mmHg

Hepatic Venous Pressure Gradient

A

Clinically significant portal HTN (cirrhosis, varices)

102
Q

HVPG: > 12 mmHg

Hepatic Venous Pressure Gradient

A

Variceal rupture

103
Q

What is asterixis?

A

flapping tremor

104
Q

What is the most liver specific enzyme?

A

Alanine aminotransferase (ALT)

105
Q

AST/ALT: Acute liver failure

A

AST/ALT elevated 25x

106
Q

AST/ALT: alcoholic liver diagnoses

107
Q

What is the primary symptom of gallstones?

A

RUQ pain, referred to shoulders

108
Q

What is choledocolithiasis?

A

stone onstructing CBD causing biliary colic

Will see cramping, N/V in addition to RUQ pain

109
Q

What is proper patient positioning for ERCP?

A
  1. Patient is prone
  2. Head to patient’s right
  3. Tape ETT to the left
110
Q

What is bilirubin?

A

end product of heme-breakdown

111
Q

Why is unconjugated bilirubin “indrect”?

A

bilirubin is bound to albumin

112
Q

What causes conjugated (direct) hyperbilirubinemia?

A

an obstruction

113
Q

Why is conjugated bilirubin “direct”?

A

H2O soluable direct state, excreted into blie

114
Q

What hepatitis requires the most liver transplantation?

115
Q

What causes unconjugated (indirect) hyperbilirubinemia?

A

Imbalance between bilirubin synthesis and conjugation

116
Q

Which hepatitis does NOT progress to chronic liver disease?

117
Q

Which hepatitis results as a coinfection with B?

118
Q

Which hepatitis causes liver disease in children?

119
Q

Which hepatitis usually develops into chronic liver disease?

120
Q

What is the most common cause of cirrhosis?

A

Alcoholic liver disease (ALD)

121
Q

A platelet count of less than what requires transfusion in ALD patients?

122
Q

Symptoms of ETOH withdrawal will occur how long after stopping?

123
Q

How much fat do hepatocytes contain?

124
Q

What is the gold standard in distinguishing NAFLD from other liver diseases?

A

liver biopsy

125
Q

What is the cause of drug induced liver injury?

A

Acetaminophen OD

126
Q

What is Wilson’s disease?

A

Hepatolenticular degeneration that is characterized by impaired copper metabolism

127
Q

What is the #1 genetic cause of liver transplantation in children?

A

a-1 antitrypsin deficiency

128
Q

What is hemochromatosis?

A

Disorder associated with excess iron in the body, leading to MODs. Likely cause is repetitive blood transfusions or high dose iron infusions

129
Q

Who does autoimmune hepatitis primarily affect?

130
Q

What is primary biliary cholangitis (PBC)?

A

Autoimmune progressive destruction of bile ducts with periportal inflammation & cholestasis

131
Q

What is primary sclerosing Cholangitis (PSC)?

A

Autoimmune chronic inflammation of the larger bile ducts

132
Q

What is cirrhosis?

A

The final stage of liver disease where normal liver parenchyma is replaced with scar tissue

133
Q

What is the most common complication of cirrhosis?

A

Ascites

Varices are present in 50% of cirrhosis patients

134
Q

What causes hepatic encephalopathy?

A

A build up of nitrogenous waste

135
Q

What is hepatorenal syndrome?

A

Excess endogenous vasodilators

136
Q

What is hepatopulmonary syndrome?

A

Triad of chronic liver diseases:

  1. Hypoxemia
  2. Intrapulmonary vascular dilation
  3. Platypnea (hypoxia when upright)
137
Q

What is portopulmonary HTN?

A

pulmonary HTN accompanied by portal HTN

138
Q

What are points in the Child Turcotte Pugh (CTP) scale based on?

A
  1. Bilirubin
  2. Albumin
  3. PT
  4. Encephalopathy
  5. Ascites
139
Q

What is the model for end stage liver disease (MELD) score based on?

A
  1. Bilirubin
  2. INR
  3. Creatinine
  4. Na+
140
Q

What is used for fluid resesitation in liver patients?

141
Q

What NMB drugs are recommended for liver patients?

A

Succs and Cisatracurium

142
Q

What is a TIPS procedure?

A

Stent or graft placed between hepatic vein and portal vein to allow portal flow into systemic circulation

143
Q

Why do we maintain a low CVP by fluid restriction for partial hepatectomy?

A

To reduce blood loss

144
Q

How do you calculate cerebral perfusion pressure (CPP)?

145
Q

What is normal CBF and how much CO does it recieve?

A

750 mL/min; 15% of CO

146
Q

How do you calculate CBF?

A

50 mL/100g brain tissue per minute

147
Q

What is a normal ICP?

148
Q

What is the monroe-kellie hypothesis?

A

Any increase in one component of intracranial volume must be offset by a decrease in another component to prevent an elevated ICP

149
Q

A reflection of dura that separates the two cerebreal hemispheres

A

Falx Cerebri

150
Q

A reflection of dura that lies rostral to the cerebellum

A

Tentorium cerebelli

151
Q

How are hernation syndromes categorized?

A

based on the region of brain affected

152
Q

Herniation: Subfalcine

A

Herniation of the contents under the falx cerebri resulting in a midline shift

153
Q

Herniation: Uncal

A

A subtype of transtentorial herniation where the uncus herniates over the tentorium cerebelli. This results in ipsilateral oculomotor nerve dysfunction.

154
Q

How can we decrease ICP?

Long list, just review it

A
  1. Elevate the head
  2. Hyperventilation - lowers PaCO2
  3. CSF drainage - EVD
  4. Hyperosmotic drugs - mannitol
  5. Diuretics - induce systemic hypovolemia
  6. Corticosteroids - decrease swelling and ehance the integrity of the BBB
  7. Propofol - decrease CRMO2 and CBF
  8. Surgical decompression
156
Q

Progressive autoimmune demyelination of cental nerve fibers

A

MS

Primarily affects women and is characterized by periods of exacerbations and remissions.

157
Q

What are two of the major preanesthetic considerations for MS patients?

A
  1. Temperature - any increase in body temp can precipitate an exacerbation of MS
  2. Avoid succynilcholine as it may induce hyperkalemia - upregulated nACh receptors
158
Q

Autoimmune disorder where antibodies are generated against nAChRs at skeletal motor endplate

A

MG

Treat with pyridostimmine
AChE inhibitors may prolong succs and Ester LA’s

159
Q

Disorder causing the development of autoantibodies against VG-Ca2+ channels

A

Eaton Lamber Syndrome

Tx: 3-4 diaminopyridine (selective K+ channel blocker

160
Q

What is the cause of Eaton-Lambert Syndrome?

A

Small Cell Lung CA

161
Q

Hereditary disorder of muscle fiber degeneration complicated by breakdown of the dystrophin-glycoprotein

A

Duchenne MD

162
Q

What are Eaton Lambert patients really sensitive to?

A

NMB both ND and D

163
Q

Prolonged contraction after muscle stimulation

164
Q

What are myotonias triggered by?

A

Stress and cold temps

165
Q

What is central core disease?

A

core muscle cells lack mitochondrial enzymes

166
Q

What causes a hypermetabolic syndrome in patients with muscular dystrophy?

A

Succs and volatile anesthetics like MH

167
Q

What are the three major types of dementia?

A
  1. Alzheimers (70%)
  2. Vascular dementia (25%)
  3. Parkinsons (5%)
168
Q

Degeneration of dopaminergic fibers of basal ganglia

A

Parkinson’s Disease

169
Q

What system does dopamine regulate?

A

regulates extrapyramidal motor system by inhibiting excess stimulation

170
Q

What medications may affect your anesthetic for dementia patients?

A

AChE-I, MAOIs, psych meds

171
Q

What is the leading cause of death and disability globally?

172
Q

What is the recommended initial treatment for acute ischemic stroke?

173
Q

What the CV risk factors related to ischemic stroke?

A
  1. HTN
  2. DM
  3. CAD
  4. Afib
  5. Vascular disease
174
Q

New anticoaglant for thrombus =

A

no elective cases within 3 months

175
Q

How quickly do anerysms need to be intervened?

A

within 72 hours

176
Q

What is a risk post SAH? For how long?

A

vasospasm for 3-15 days post op

177
Q

What is the aim for anerysms pre anesthesia?

A

BP control to avoid rupture

178
Q

Anerysm Grading

Long just read

A
  1. Unruptured
  2. Ruptured, no deficits
  3. Moderate to severe HA
  4. Drowsiness, confusion
  5. Stupor, hemiparesis
  6. Deep coma, decerbrate rigidity
179
Q

What are the major symptoms of an anerysm?

A
  1. HA
  2. Photophobia
  3. Confusion
  4. Hemiparesis
  5. Coma
180
Q

What is triple H therapy?

A
  1. Hypertension
  2. Hypervolemia
  3. Hemodilution
181
Q

Arterial to venous connection without intervening capillaries creating an area of how flow to low resistance shunting

A

AV malformations

182
Q

What is chiari malformation?

A

Congenital displacement of the cerebellum

Type 1: Downward displacement
Type 2: downward displacement of cerebellar vermis
Type 3: Occipital encephalocele
Type 4: non compatible with life

183
Q

What is Bourneville Disease (Tubular Sclerosis)?

A

Disease causing benign hematomas, angiofibromas, and other malformations that can occur anywhere

Can present with retardation and seizure disorders

184
Q

Benign tumors of the CNS, eyes, adrenals, pancreas, and kidneys

A

Von Hippel-Lindau Disease

May present with pheochromocytoma

185
Q

A disorder of CSF accumulation causing increase ICP that results in ventricular dilation

A

Hydrocephalus

186
Q

Primary Injury

A

Occurs at the time of insult

187
Q

Secondary injuries

Long list, read

A
  1. Neuroinflammation
  2. Hypoxia
  3. Anemia
  4. Cerebral edema
  5. Electrolyte imbalances
  6. Neurogenic shock
188
Q

Transient, paroxysmal, synchronous discharge of neurons in the brain

189
Q

How do you intubate post seizure?

A

RSI with cricoid pressure

190
Q

When is surgery indicated for an aortic anerysm?

191
Q

Uniform dilation along entire circumference of arterial wall

192
Q

Berry-shaped bulge to one side

193
Q

What is the safest/fastest measure of obtaining a diagnosis of a dissected aneurysm?

A

Doppler echocardiogram

194
Q

What needs to be on board before surgeries on seizure patients?

A

anti-seizure medications

195
Q

Tear in the intimal layer of the vessel causing blood to enter the medial layer

A

Dissection

196
Q

Which type of dissection is “catastrophic”?

197
Q

What is the major complication of a Stanford A dissection?

A

Neurological deficits

198
Q

What two types of dissection are part of Stanford A?

A

Ascending aorta & aortic arch

199
Q

What type of dissections are type B?

A

Descending thoracic aorta

200
Q

What dissections are treated with medical therapy?

A

Stanford B

unless they have signs of impending rupture

201
Q

What are signs of impending rupture?

A
  1. Persistent pain
  2. Hypotension
  3. Left-sided hemothorax
202
Q

Which dissection is an emergency?

A

Ascending arch

Uncomplicated type B rarely treated with urgent surgery

203
Q

What can cause a dissection?

A
  1. Cocaine
  2. Blunt trauma
  3. Iatrogenic causes
204
Q

What is iatrogenic?

A

Cardiac catheterization, aortic manipulation, cross clamping, and arterial incision

205
Q

What is the aortic aneurysm triad?

A
  1. Hypotension
  2. Back pain
  3. A pulsatile abdominal mass
206
Q

Where do most abdominal aortic aneurysms rupture?

A

left retroperitoneum

207
Q

What can euvolemic resuscitation lead to in an aneurysm?

A

Retroperitoneal tamponade

208
Q

Caused by a lack of blood flow to the anterior spinal artery

A

Anterior spinal artery syndrome

209
Q

The anterior spinal artery is responsible for perfusing the anterior ______ of the spinal cord

210
Q

What can cause anterior spinal artery syndrome?

A
  1. Aortic aneurysms
  2. Aortic dissection
  3. Atherosclerosis
  4. Trauma
211
Q

What is the number 1 leading cause of disability in the US?

A

Stroke

It’s also the 3rd leading cause of death in the US

212
Q

How quickly does TPA need to be given?

A

Within 4.5 hours

213
Q

When is a cartoid endarectomy indicated?

A

Lumen diameter 1.5mm or >70% blockage

214
Q

What affects cerebral oxygenation?

A
  1. MAP
  2. CO
  3. SaO2
  4. Hgb
  5. PaCO2
215
Q

What defines PAD?

216
Q

What are two of the primary signs of PAD?

A
  1. Intermittent claudation
  2. Resting extremity pain
  3. Coolness
  4. Hairloss
217
Q

Why do patients with PAD get relief when hanging their LE over the side of the bed?

A

Increases hydrostatic pressure

218
Q

What causes subclavian steal syndrome?

A

occluded SCA proximal to vertebral artery

219
Q

What will the SBP of the affected arm in subclavian steal syndrome me?

A

20 mmHg lower

220
Q

What does a doppler US show?

A

Pulse volume waveform that can identify arterial stenosis

221
Q

What does duplex US show us?

A

Can identify areas of plaque formation and calcification

222
Q

What are 3 examples of PVD?

A
  1. Superficial thrombophlebitis
  2. DVT
  3. Chronic venous insufficiency
223
Q

What is virchow’s triad?

A
  1. Venous stasis
  2. Hypercoaguability
  3. Distrupted vascular endothelium
224
Q

LMWH advantages and disadvantages

Just read

A

A
1. Longer Half-Life
2. Less risk of bleeding
DA
1. Higher cost
2. Lack of reversal agent

225
Q

Who is high risk for DVT?

long list

A
  1. Age > 40
  2. Operation > 60 minutes
  3. Previous Hx of stroke, DVT, embolism
  4. Knee or hip replacement
  5. Major fractures
  6. Extensive trauma
226
Q

What may be observed frequently during and after carotid endarterectomy?

A

Hypo and hypertension

227
Q

An inflammatory vasculitis leading to occlusion of small and medium-sized arteries and veins in the extremities

A

Thromboangitis

228
Q

What complications are the leading cause of perioperative morbidity and mortality?

A

Cardiac complications

229
Q

What typically causes an acute arterial occlusion?

A

Cardiogenic embolism

230
Q

Large Artery vasculitis

A

Takayasu artheritis
Temporal artheritis

231
Q

Medium to small-artery vasculitis

A

Thromoboangiitis obliterans
Wegener granulomatosis
Polyartheritis nodosa

232
Q

Medium-artery vasculitis

A

Kawasaki disease

233
Q

Inflammation of arteries of the head and neck

A

Temporal (giant cell) arteritis

234
Q

An inflammatory vasculitis leading to small & medium vessel occlusions in the extremities caused by an autoimmune response that was triggered by nicotine

A

Thromboangiitis Obliterans “Buerger Disease”

235
Q

What happens in 50% of total hip placements?

A

Superficial thrombophelbitis and DVT

236
Q

What can greatly improve post op ambulation and decrease DVT?

A

Regional anesthesia

237
Q

Antineutrophyl cytoplasmic antibody negative vasculitis

A

Polyarteritis nodosa

238
Q

What is the primary cause of death for patients polyarteritis nodosa?

A

Renal failure

239
Q

What is indicated by a retrograde blood flow > 0.5 seconds?

A

Lower extremity chronic venous insufficiency

Spring 2024 (9 decks)

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