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Anesthesia > ITE > Flashcards

ITE Flashcards

1
Q

Function of carotid body chemoreceptors

A

Increase minute ventilation in response to PaO2 less than 60

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2
Q

Lungs are extensively involved in metabolism but play no role in metabolizing what key substances?

A 
Dopamine
Epinephrine 
Vasopressin 
Oxytocin 
PgI2 and PgA2
Angiotensin I
Histamine
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3
Q

Factors that up regulate ACh receptors

A 
Stroke
Burns >24h
Immobility
MS
ALS
Guillain barre
Muscular dystrophy
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4
Q

Disease that causes down regulation of ACh receptors

A

Myasthenia gravis

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5
Q

Describe the hepatic arterial buffer response

A

Decreased flow to the portal vein leads to accumulation of adenosine which causes dilation and increased flow to the hepatic artery

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6
Q

What are the nerves involved in the laryngospasm reflex?

A

Afferent: internal branch of the superior laryngeal nerve

Efferent: recurrent laryngeal nerve

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7
Q

Haldane effect

A

The process of O2 binding to hgb and displacing CO2 from the blood. This causes a downward shift of the CO2 dissociation curve

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8
Q

Bohr effect

A

Hypercarbia causes a right shift of the oxyhemoglobin saturation curve, increases oxygen unloading to the tissues

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9
Q

Dibucaine number: normal, heterozygous, homozygous

A

Normal: 80
Heterozygous: 40-70
Homozygous: 20

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10
Q

Three complications of TURP and their presentations

A

Glycine toxicity: hyperammonemia causes CNS symptoms including N/V, transient blindness

Hyponatremia causes CNS symptoms

Bladder perforation causes N/V, abdominal or shoulder pain

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11
Q

Dead space: what is it? What increases it?

A

Ventilation without perfusion

Increased by upright positioning, bronchodilation, neck extension, low cardiac output

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12
Q

Stroke ACLS:
Fibrinolysis should be initiated within xx hours of arrival to hospital? Xx hours of symptom onset?

Evaluation by neurology should occur within what timeframe?

Goal BP? What drugs should be used for hypertension?

Goal sats?

Goal BG?

Goal T?

A

Fibrinolysis within 1hr of arrival to hospital, 4.5 hrs of symptom onset

Eval by neuro within 10m of arrival

Goal BP <185/110 using labetalol, nicardipine

Sat>94%

BG 140-180

T<38

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13
Q

What effect does lipid solubility of opioids have on epidural spread?

A

As opioids cross the dura and enter the CSF, highly lipophilic drugs like fentanyl will remain at the level of injection

Opioids with low lipid solubility like morphine will diffuse and have a wide spread in CSF

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14
Q

What factor of local anesthetics affects their spread within the intrathecal space? The epidural space?

A

Baricity affects intrathecal spread

Lipophilicity affects epidural spread

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15
Q

CO2 is transported in the blood in what three forms?

A

Bicarbonate (73%)
Hgb-bound (20%)
Dissolved (7%)

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16
Q

Dalton’s law

A

Total pressure is sum of partial pressures

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17
Q

Boyle’s Law

A

Pressure is inversely related to volume at a constant temperature

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18
Q

Contraindications to closed circuit or low flow anesthetic

A

Sevo
Alcoholism
Cirrhosis
DKA

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19
Q

Factors involved in Aldrete Score

A 
Respiration
SpO2
BP
Consciousness
Extremity movement
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20
Q

Drugs metabolized by Cyp2C9

A

Warfarin
Ibuprofen
Phenytoin

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21
Q

Drugs metabolized by Cyp2D6

A

Beta blockers
Codeine
Diltiazem
Tramadol

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22
Q

Drugs metabolized by cyp2C19

A

Omeprazole

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23
Q

Drugs metabolized by MC1R

A

Morphine

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24
Q

Effect of phenytoin use on neuromuscular blockade: Acute v chronic

A

Acute phenytoin use potentiates blockade

Chronic phenytoin use reduces sensitivity to NMBDs

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25
Q

4 most accurate sites of the body for temperature monitoring

A

Tympanic membranes
Nasopharynx
Distal esophagus
Pulmonary artery

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26
Q

Metabolic derangements associated with alcoholism

A 
Hypokalemia
Hypomagnesemia
Hyponatremia
Metabolic acidosis
Respiratory alkalosis
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27
Q

Triad of cyanide toxicity

A

Metabolic acidosis
Increased mixed venous O2
Tachyphylaxis

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28
Q

Fenoldapam:
MOA
Second messenger
Effects

A

Dopamine 1 agonist
cAMP stimulation
Causes peripheral vasodilation, decreased preload and afterload, diuresis, and natriuresis

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29
Q

Nesiritide: MOA, effects

A

Recombinant brain natriuretic peptide that acts as a counter hormone to angiotensin II, norepinephrine, and endothelin. Causes arterial and venous dilation, diuresis, and natriuresis.

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30
Q

With nitrous administration, how quickly will a PTX double? Triple?

A

Double in 10m, triple in 30m

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31
Q

Definition of anuria? Oliguria?

A

Anuria: less than 50cc/d
Oliguria: less than 0.5cc/kg/hr or <400cc/d

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32
Q

What two factors increase the rate of Hoffman elimination?

A

Increased pH, increased temperature

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33
Q

Perioperative Hypothermia can lead to what adverse outcomes?

A

Infection
impaired Healing
Cardiac events
Blood loss

It’s Hella Cold B!

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34
Q 
Metabolism/renal elimination/hepatic elimination of:
Rocuronium
Vecuronium
Cisatracurium
Pancuronium
A

Roc: no metabolism/20% renal/>70% hepatic
Vec: 30% hepatic metabolism/45% renal/55% hepatic
Cis: 77% Hoffman elimination/ 15% renal/no hepatic
Pan: 15% hepatic metabolism/85% renal/ 15% hepatic

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35
Q

Which neuromuscular blocking drugs have active metabolites that accumulate in renal failure and prolong NMB?

A

Pancuronium and vecuronium

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36
Q

Borders of: nasopharynx, oropharynx, larynx

A

Nasopharynx: base of skull to soft palate

Oropharynx: soft palate to epiglottis

Larynx: epiglottis to cricoid cartilage

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37
Q

Most common valve abnormalities associated with rheumatoid arthritis

A

Mitral and aortic regurgitation

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38
Q

Acute changes with bicarbonate administration

A

Increase PaCO2, etCO2
Transient decrease Ca, K
Elevated ICP (controversial)

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39
Q

Roller pump v. Centrifugal pump for bypass: what determines flow for each type? What patient characteristic determines type used? What are benefits of centrifugal?

A

Roller pumps are used in pediatrics and flow is dependent on roller speed

Centrifugal pumps are used with adults and flow is dependent on preload and afterload.

Centrifugal pumps result in less blood destruction, decreased wear on the tubing which leads to less spalation (plastic emboli) and less inflow and out outflow obstruction.

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40
Q

FEV1, FVC, FEF 25-75, and FEV1:FVC ratio for obstructive and restrictive pulmonary disease

A

Obstructive: FEV1 ⬇️, FVC nml, FEF 25-75 ⬇️, FEV1:FVC ⬇️

Restrictive: FEV1 ⬇️, FVC ⬇️, FEF 25-75 nml, FeV1:FVC nml

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41
Q

Main steps in formation of arteriosclerotic thrombus

A

Lipid laden macrophage invasion (foam cells), formation of smooth mm and collagen cap, calcium accumulation, plaque rupture allows for interaction with platelet to form a thrombus which can remain local or embolize.

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42
Q

Autonomic derangements seen with aging

A 
Increased sympathetic activity
Decreased parasympathetic activity
Decreased baroreceptor responsiveness
Decreased beta receptor responsiveness
No change in alpha receptor responsiveness
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43
Q

Potential adverse effects of celiac plexus block? Most common? Indications for celiac plexus block?

A

Adverse effects: orthostatic hypotension (most common) with reflex tachycardia, diarrhea, hiccups, pleurisy, retroperitoneal bleeding, abdominal aortic dissection, paraplegia, transient paralysis.

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44
Q

CRPS: what is the difference between type I and type II? What treatments are available?

A

Type 1- no nerve damage
Type 2- nerve damage

Tx: Physical therapy—> TCA —> sympathetic block (confirm by checking that temperature increases in the affected limb). Last resort SCS.

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45
Q 
What do the following EEG waveforms indicate?
Alpha
Beta
Gamma
Delta
Theta
A

Alpha-awake, resting
Beta-sedation vs awake and concentrating
Gamma-cortical processing
Delta and theta-sleep and sedation

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46
Q

Enzyme inhibited by etomidate? Effects?

A

Inhibits 11 beta hydroxylase, causes adrenal suppression with decreased secretion of aldosterone and cortisol

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47
Q

Risk factors PONV pediatric patients

A

> 30m surgery
3 years
H/o PONV in patient, parent, or sibling
Strabismus surgery

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48
Q

Indications for intracranial ICP monitoring in pts with severe TBI

A

GCS<8 with abnormal head CT or normal head CT but two of the following:
Age>40, SBP <90, posturing

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49
Q

Desired spinal level with TURP

A

T10, umbilicus

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50
Q

Commonly used anesthetic drugs that do not cross the placenta? General rule of thumb re: what crosses placenta?

A 
Sux
NDNMBDs
Glycopyrrolate
Heparin
Insulin

Things that cross BBB generally cross placenta

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51
Q

Hypersensitivity reactions to aminoamides are usually due to? Name the aminoamides.

Hypersensitivity reactions to aminoesters are usually d/t? Name the aminoesters.

What type of reactions are seen and how do they present?

A

Aminoamides: rxn to preservatives (methylparaben). Lido, prilo, bupi, mepiv, ropiv

Aminoesters: rxn to metabolic byproduct parabenzoic acid. Procaine, tetracaine, chloroprocaine, cocaine. (Mnemonic PABA can cause trouble)

Type 1, IgE mediated anaphylaxis (rare)
Type 4, 12-48h dermatitis

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52
Q

Medication to avoid with stereotactic deep brain stimulator placement? Why?

A

Midazolam because it interferes with microelectrode recordings

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53
Q

List the transplantable organs in order of shortest allowable ischemic time to longest alllowable

A

Heart, lungs, liver, intestines, pancreas, kidneys

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54
Q

Temperature at which burst suppression occurs? Complete suppression of EEG activity occurs?

A

Burst suppression below 25C, complete suppression below 18C

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55
Q

Barbiturate metabolism and excretion

A

Hepatic metabolism, biliary conjugation, renal excretion

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56
Q

Hemodynamic goals during cardiopulmonary bypass

A

Pump flow 1.5-3L/m/m^2
MAP 50-90mmHg
Venous O2 sat>65%

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57
Q 
Warfarin:
MOA?
Coag factors affected?
Is it safe in pregnancy? Breastfeeding? ESRD?
Monitoring?
Metabolism?
A

MOA: inhibits vitamin K reductase, traps vitamin k in inactive form

Factors affected: 2, 7, 9, 10, C, S

Contraindicated in pregnancy. Safe with breastfeeding and ESRD.

Monitoring with PT/INR

Metabolized by Cyp2C9

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58
Q

Metabolic derangements associated with increased risk of digoxin toxicity

A

Hypokalemia
Hypercalcemia
Hypomagnesemia

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59
Q

What percent of blood flow to the liver is delivered via the portal vein? Hepatic artery? What percent of O2 supply is delivered by each?

A

Portal vein: 75% blood flow, 50% oxygen supply

Hepatic artery: 25% blood flow, 50% oxygen supply

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60
Q

Most common causes of atlantoaxial instability

A

Achondroplasia
Downs
RA

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61
Q

Pulmonary parameters that increase with aging? Decrease? No change?

Functional residual capacity
Closing capacity
Total lung capacity
Vital capacity
Inspiration capacity
Residual volume
Inspiratory reserve volume
Expiratory reserve volume
Tidal volume
A

⬆️ FRC, RV, CC
⬇️ TLC, VC, IC, IRV
no change: ERV, VT

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62
Q

By what mechanism does nitrous inhibit DNA synthesis?

A

Irreversibly inactivates B12 via oxidation of cobalt atom, which inhibits methionine synthetase

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63
Q

Frequent cosmetic use is associated with allergy to what substance?

A

Amino steroid neuromuscular blocking drugs: pancuronium, vecuronium, rocuronium, pipercurium

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64
Q

Symptoms of propofol infusion syndrome (aka propofol toxicity)

A 
Bradycardia
Acidosis (metabolic)
Rhabdo 
Fatty liver
Hyperkalemia
Lipemia
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65
Q

Considerations for peds spinals

A

Higher CSF volume per kg
Spinal cord ends at L3
Dural sac ends at S3
No bradycardia side effects with spinals

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66
Q

Myxedema coma symptoms

A

Non-pitting edema, hypotension, hypothermia, hypoventilation, AMS

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67
Q

List routes of midazolam in order of bioavailability from greatest to least

A

IV, subQ, IM, sublingual, intranasal, rectal, oral

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68
Q

Relationship between wavelength and frequency on US penetration and resolution

A

Increased wavelength (decreased frequency) achieves greater depth of penetration.

Increased frequency (decreased wavelength) achieves greater resolution.

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69
Q

What medication class is contraindicated for treatment of malignant hyperthermia? Why?

A

Calcium channel blockers interact with dantrolene to cause cardiac instability and hyperkalemia

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70
Q

Serotonin syndrome presentation

A

Tachycardia, clonus, hyperreflexia, ataxia, AMS

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71
Q

Aminocaproic acid and TXA MOA

A

Antifibrinolytic lysine analogs that bind plasminogen/TPA complexes to prevent plasmin formation. This prevents plasmin from binding to fibrin clots and initiating their breakdown.

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72
Q

Formula for standard error of the mean

A

Std deviation/ sqrt(n)

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73
Q 
Milrinone MOA, 2nd messenger, and effects on:
Lusitropy
Inotropy
PVR
SV
A 
MOA: phosphodiesterase 3 inhibitors
Second messenger: cAMP
Lusitropy ⬆️
Inotropy ⬆️
PVR ⬇️
SV ⬆️
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74
Q

Nerve that is spared in brachial plexus blocks and can cause tourniquet pain. What is the nerve’s sensory distribution?

A

Intercostobrachial; medial upper arm

75
Q

Cardiac anomaly assoc w omphalocele

A

VSD

76
Q

Cardiac anomalies assoc w Turner syndrome

A

Bicuspid aortic valve and aortic coarctation

77
Q

Syndrome associated with conotruncal abnormalities including tetralogy of fallot

A

DiGeorge 22q11 deletion

78
Q

Anesthetic that increase hepatic blood flow

A

Propofol

79
Q

MAC decreases by what percent per decade of life?

A

6%

80
Q

Block of choice for treatment of chronic pelvic pain as with gynecologic malignancies? Where is the target located?

A

Superior hypogastric block at lower third of L5 anterior to the aortic bifurcation

81
Q

Block of choice for chronic, sympathetically mediated upper extremity pain

A

Stellate ganglion block

82
Q

Glucagon:
What stimulates secretion?
Where is it secreted from?
Effect on gluconeogenesis? Glycogenolysis? Lipolysis? Glycolysis? Glycogen synthesis?

A

Secreted by alpha cells of pancreas IRT hypoglycemia, catecholamines.
Increases gluconeogenesis, glycogenolysis, and lipolysis (to increase free fatty acids and glycerol for gluconeogenesis)
Decreases glycolysis and glycogen synthesis.

83
Q

Potential complication of occluded oxygenator outflow during cardiopulmonary bypass

A

Pressure in gas chamber can exceed pressure in blood chamber and cause arterial air embolus

84
Q

Ultrasound has a frequency above what threshold?

A

2000 cycles/second

85
Q

Effect of thyroid hormone on potassium levels?

A

Promotes cellular uptake of potassium, leading to decreased serum K

86
Q

Best commonly administered drug for suppressing cough reflex? Laryngospasm reflex?

A

Cough: opioids
Laryngospasm: propofol

87
Q

Ideal angle of incidence of probe when measuring cardiac output by esophageal Doppler?

A

Zero degrees

88
Q

Dominant pressure driving movement of water across the BBB in normal healthy state? In cases of BBB disruption?

A

Healthy: oncotic pressure
Disrupted: hydrostatic pressure

89
Q

Which crosses the BBB: atropine or glycopyrrolate?

A

Atropine

90
Q

Mechanism of acute hemolytic transfusion reaction? Presentation?

A

ABO incompatibility

P/w chills, fever, N/V, hemoglobinuria, bleeding distress, hypotension

91
Q

Mechanism of delayed hemolytic transfusion reaction? Time course? Pt characteristics?

A

Incompatibility with minor erythrocyte antigens (Rh, Kidd)

Presents 2-21 days post transfusion

More common in females of childbearing age (prior pregnancy, prior silent miscarriage) and pts who have been transfused in the past.

92
Q

Mechanism of non-hemolytic febrile transfusion reaction? Presentation? Treatment? Prevention?

A

Recipient antibodies against antigens on donor leukocytes or platelets.

P/w chills, fever, N/V, cough

Tx: APAP, Benadryl

Prevent by leukoreducing blood products

93
Q

TRALI MOA. Incidence is declining significantly d/t what intervention?

A

Donor antibodies attack recipient leukocytes. Incidence decreasing d/t restriction of women of childbearing age from donating plasma.

94
Q

What happens when an IgA deficient patient is transfused blood product with IgA? What is the mechanism?

A

Acute anaphylaxis as donor IgA activates recipient mast cells

95
Q

Describe why gas will preferentially be delivered via supply line instead of cylinder even if cylinder valve is left open.

A

Pipeline pressure is greater than cylinder pressure (as long as cylinder pressure regulator is functional), so gas will only flow from the lower pressure cylinders if pipeline pressure drops.

96
Q 
Color codes of cylinders:
O2
Air
N2O
CO2
N
He
A 
O2: green
Air: yellow
N2O: blue 
CO2: gray
N: black
He: brown
97
Q

Pressure (PSI) and volume (L) of O2, air, and N2O cylinders?

A

O2: 2000 PSI, 625 L
Air: 1800 PSI, 625 L
N2O: 750 PSI, 1600 L

98
Q

Volatile anesthetics in order of ascending blood gas partition coefficient

A

Des, Nitrous, Sevo, Iso, En, Halo

99
Q

Volatile anesthetics in order of ascending vapor pressure

A

Sevo, en, iso, halo, des, nitrous

100
Q

Major risk of enflurane?

A

Seizure (enflurane = epileptic)

101
Q

Major risks of halothane?

A

Hepatotoxicity and arrhythmia

102
Q

Poiseuille’s Law

A

Flow through a tube= (pipressure differencer^4)/8viscositylength of tube

As viscosity and length increase, flow decreases
As pressure change and radius increase, flow increases

103
Q 
Effects of pregnancy on: 
FRC
ERV
RV
IC
IRV
VT
VC
TLC
A 
FRC ⬇️
ERV ⬇️
RV ⬇️
IC ⬆️
IRV ⬆️
VT ⬆️
VC↔️
TLC ↔️
104
Q

Pre-op treatment of Von Willebrand type 1? Type 2? Type 2b? Type 3? Acquired antibody mediated?

Which is most common?

A 
Type 1: Desmopressin (most common)
Type 2: desmospressin 
Type 2b: vwf concentrate
Type 3: vwf concentrate
Acquired ab-mediated: IVIG
105
Q

Level of spinal cord injury in quadriplegia? Paraplegia?

A

Quadriplegia: C1-8 spinal cord level
Paraplegia: T1-L5

106
Q

Why is work of breathing increased in infants compared to adults?

A

Increased chest wall compliance causing functional airway closure with each breath

Fewer type 1 slow twitch fibers increases fatiguability

Smaller diameter airways

Higher MV to keep up with increased relative oxygen demand

107
Q

Triad of hepatopulmonary syndrome? Other characteristic symptoms?

A

Triad: Increased Aa gradient >20, liver failure, intrapulmonary vascular dilation (d/t excess NO)

Other: platypnea and orthodeoxia (worsened SOB with standing; standing causes blood to pool in lower lungs where ventilation is poorest which increased VQ mismatch)

108
Q

VQ values approached with dead space and shunt

A

Dead space: high VQ mismatch, approaches infinity

Shunt: low VQ mismatch; approaches zero

109
Q 
What product is indicated with each of the following TEG findings?
Decreased MA
K value prolongation
R value prolongation
Teardrop configuration
A

Decreased MA: platelets
K value prolongation: cryo
R value prolongation: FFP
Teardrop configuration: antifibrinolytics

110
Q

Formula for coronary perfusion pressure

A

Coronary Perfusion pressure = Aortic diastolic pressure - LVEDP

111
Q

Cushing Triad of elevated ICP

A

HTN
Bradycardia
Respiratory changes

112
Q

Indications for intraaortic balloon pump counter pulsation? Contraindications?

A

Indications: RV dysfunction, carcinogenic shock, as a bridge to definitive therapy (transplant v VAD), severe MR, failure to wean from CPB, during PCI

Contraindications: Aortic disease, AI, severe peripheral vascular disease

113
Q

Which anesthetic is associated with high complication rates when used for pediatric radiation therapy?

A

Ketamine

114
Q

Carcinoid syndrome:
What is it?
Sx?
Dx?

A

GI malignancy wherein enterochromaffin cells release serotonin
Dx by increased urine 5 HIAA (serotonin metabolite)
Dx: episodic flushing, diarrhea, right heart disease with pulmonary stenosis, wheezing d/t bronchospasm, hyperglycemia

115
Q

Bio stats: Formula for calculating sensitivity?

A

Sn= TP/(TP + FN)

116
Q

Bio stats: formula for calculating PPV?

A

PPV= TP/(TP + FP)

117
Q

Supplements that interfere with platelet function

A

Ginger
Ginkgo
Garlic
Vitamin E

118
Q

Major risk factors for post op AKI

A

Surgery specific: intrathoracic, intraperitoneal, vascular, significant blood loss

COPD
Obesity
Peripheral vascular occlusive dz
Age 59+
Liver dz
119
Q

Expected FENa, BUN:Cr with prerenal AKI

A

FENa <1

BUN:Cr >20:1

120
Q

Factors that affect level of spinal anesthesia

A 
Dose (volume * concentration)
Injection site
Baricity
Pt posture
CSF volume and density
121
Q

What constitutes a clinically significant change in Evoked Potentials?

A

50% decrease in amplitude

10% increase in latency

122
Q

Neuro vascular structures of the antecubital fossa in order from medial to lateral

A

Median n, brachial a, radial n

123
Q 
Estimated blood volume in cc/kg:
Premature neonate
Term neonate
Infant
Child
Adult male
Adult female
A 
Premature neonate: 100cc/kg
Term neonate: 90cc/kg
Infant: 80cc/kg
Child: 75cc/kg
Adult male: 70cc/kg
Adult female: 65cc/kg
124
Q

Best way to diagnose cerebral vasospasm after SAH? Tx?

A

Dx: cerebral angiography
To: triple H—hypertension, hypervolemia, hemodilution + nimodipine, balloon angioplasty

125
Q

Meds that can be used to identify seizure foci intraoperatively?

A

Etomidate, sufentanil, alfentanil

126
Q

Chemo drugs associated with cardiomyopathy? What should be avoided intraop if pt is taking one of these drugs?

Chemo drug associated with interstitial pnuemonitis? What should be avoided intraop if pt is taking this drug?

A

Cardiomyopathy: doxorubicin, rituximab, 5FU, cyclophosphamide, paclitaxel. Avoid excessive IVFs

Interstitial pneumonitis: bleomycin. Avoid 100% O2, lidocaine.

127
Q

Components of biophysical profile?

A

Non stress test, fetal breathing, movement and muscle tone, amniotic fluid volume

128
Q

Pulmonary parameters unchanged in obese pts? Decreased?

A

Unchanged: closing capacity, residual volume

Decreased: TLC, VC, FRC, and ERV. ERV affected most.

129
Q

Side effects of fospropofol?

A

Paresthesias (often genital, perianal) and genital pruritis

130
Q

SSEP pathway?

MEP pathway?

A

SSEP: peripheral nerve➡️ dorsal root ganglion➡️ posterolateral spinal cord➡️ medial lemniscus (in brain stem)➡️ thalamus➡️ cortex

MEP: cortex➡️ internal capsule➡️ brain stem➡️ corticospinal tract➡️ peripheral nerve

131
Q

Magnesium effect on neuromuscular blockade

A

Prolongs blockade of polarizing and non-depolarizing NMBDs

132
Q

Lithium effect on neuromuscular blockade

A

Potentiates non depolarizing NMBDs

133
Q

Where do the cardiac accelerating sympathetic fibers originate?

A

T1-T4

134
Q

When do infants develop physiologic anemia of the newborn? How low do hgb levels drop?

A

8-12 weeks

Hgb~11

135
Q

Treatment of botulism in infants v adults?

A

Infants: human-derived immune globulin
Adults: equine-derived antitoxin

136
Q

Risk factors for adverse events during pediatric sedation

A 
ASA 3+
Ages less than 3mos
Airway procedures
Obesity
Multiple drug combinations
137
Q

When do accelerations and decelerations on fetal heart tracing lead to change in baseline fetal heart rate?

A

When they last >10m

138
Q

Cause of early decelerations on fetal heart tracing?
Late decelerations?
Variable?

A

Early: fetal head compression, vagal stimulation.
Late: uteroplacental insufficiency or myocardial depression d/t hypoxia
Variable: cord compression

139
Q

Potential complications of brachial artery cannulation?

A

Median n damage
Distal ischemia d/t lack of collaterals
Catheter related blood stream infections

140
Q

Which local anesthetic has the lead amount of placental transfer via epidural route? Why?

A

2-chloroprocaine bc it is rapidly metabolized by plasma cholinesterase

141
Q

The onset of local anesthetic is affected by what 4 factors?

A 
Concentration (higher is faster)
Lipid solubility (higher is faster)
Environmental pH (higher is faster)
pKA (lower is faster = more unionized at physiologic pH)
142
Q

Myasthenia gravis: affect on neuromuscular blockade

A

Resistant to sux
More susceptible to nondepolarizing NMBDs

Pyridostigmine use can decrease the efficacy of NDNMBDs

143
Q

EKG changes with hypermagnesemia?

Hypercalcemia?

A

Hypermagnesemia: long PR, wide QRS
Hypercalcemia: short QT

144
Q

Tx organophosphate poisoning

A

Pralidoxime chloride
Atropine
Decontamination
Supportive care

145
Q

Volatile agent that most significantly augments neuromuscular blockade?

A

Desflurane

146
Q

Hemodynamic goals for brain dead donors for organ procurement

A

Hematocrit >30%
UOP 1cc/kg/hr or more
MAP 60+
EF 45% or more

147
Q

Management of Acute mountain sickness

A 
Acetazolamide
Hyperbaric chamber
Descent
O2
Water (hydration)
Non-bento sleep aids

AH go DOWN

148
Q

Medication that should be avoided in pediatric patients post-tonsillectomy? Why?

A

Codeine
Prodrug activated by Cyp2D6 to morphine. Because of variable metabolism, rates of conversion to morphine are unpredictable and fast metabolizers can accumulate morphine, leading to respiratory depression. Has been linked to post-op deaths.

149
Q

Which of the following drugs should be dosed to TBW? IBW? LBW?

Propofol—induction v maintenance
Opioids
NDNMBDs
Sux

A

TBW: sux, maintenance propofol
IBW: NDNMBDs
LBW: propofol (indxn), opioids

150
Q

Fresh gas flow required for spontaneous ventilation with Mapleson A circuit? Spontaneous ventilation with Mapleson DEF? Controlled ventilation with DEF?

A

Spontaneous A: equal to MV
Spontaneous D, E, F: 2-3xMV
Controlled D, E, F: 1-2x MV

151
Q

Propofol mechanism of action (be specific). Which other medication class shares this MOA?

A

Decreases the dissociation of GABA from its receptor by causing increased chloride ion influx and thus hyperpolarization; hyperpolarization makes the cell membrane resistant to excitatory neurotransmitter impulses.

Barbiturates have the same MOA.

152
Q

Predictors of postoperative ventilation in pts with myasthenia gravis

A

Duration of disease 6 yrs or more
Concomitant respiratory disease
Pyridostigmine dose >750mg/d
VC <2.9L

153
Q

Parkinson’s disease pathophysiology

A

Loss of dopamine secreting neurons in the substantia nigra of the basal ganglia

154
Q

What are the risk factors for intraoperative awareness?

A

Cardiac surgery, ob surgery, and trauma surgery

155
Q

What is Conn syndrome? How is it treated?

A

Primary hyperaldosteronism caused by aldosterone-producing adrenal adenoma. Tx with spironolactone and potassium depletion prior to adenoma resection.

156
Q

Medication that should be given before surgery on pts with catecholamine-producing tumors?

A

Phenoxybenzamine, a non-specific alpha blocker

157
Q

Type I vs type II hepatorenal syndrome

A

Type I: Acute renal failure caused by an inciting event in a cirrhotic patient. Type I improves with treatment.

Type II: progressive, insidious onset renal failure in a cirrhotic pt with no precipitating event. Does not respond to treatment except transplant.

Transplant is definitive tx for both types.

158
Q

Half life of albumin?

A

3 weeks

159
Q

Absolute contraindications to ECT

A 
Brain tumor
Brain surgery in last 3mos 
Unstable C spine
MI in last 6 weeks
Pheochromocytoma
Stroke in last 3 mos
160
Q

Similarities and differences of cerebral salt wasting and SIADH?

A

Both present with hyponatremia and high urine sodium and osms.

SIADH p/w euvolemia or hypervolemia and is treated with water restriction

Cerebral salt wasting p/w hypovolemia and is treated with salt and water replacement.

161
Q

Mechanism of pre-eclampsia development?

A

Thromboxane A2 is a potent vasoconstrictor. With pre-e, thromboxane A2 levels are increased, leading to global vascular reactivity and vasoconstriction with elevated SVR, as well as uterine vasoconstriction with decreased placental/uterine blood flow.

162
Q

Timeframe after SAH when rebleeding occurs vs vasospasm

A

Rebleeding: peaks at 24hrs
Vasospasm: 3-10d

163
Q

Butorphanol MOA? Buprenorphine MOA? Methadone MOA?

A

Butorphanol: mu agonist/antagonist, kappa agonist

Buprenorphine: mu agonist, kappa antagonist

Methadone: mu agonist, NMDA antagonist

164
Q

Cole formula pediatric ETTs

A

Age/4 +4

Subtract half a size for cuffed

165
Q

What property of bupivicaine accounts for its low placental transfer?

A

Highly protein bound

166
Q

Muscle involved in relieving obstruction with jaw thrust

A

Genioglossus muscle. It anchors the tongue to the mandible.

167
Q

What two substances are mixed for each of the following:
ABO type?
Antibody screen?
Crossmatch?

A

ABO type: recipient RBCs with commercial serum

Antibody screen: recipient serum with commercial RBCs

Crossmatch: recipient serum and donor RBCs

168
Q

MOA of neuraxial opioids?

A

Act at mu receptors in the substantia gelatinosa in the dorsal horn of the spinal cord to inhibit afferent excitatory inputs and prevent release of substance P and glutamate

169
Q

Alveolar gas equation

A

PAO2= FiO2 * (Patm - PH2O) - (PaCO2/R)

PH2O is 47
Patm is 760 at sea level
R is respiratory quotient and is usually 0.8

170
Q

Apnea hypopnea index:
Mild OSA
Moderate OSA
Severe OSA

How is it calculated?

A

Mild: 5-14
Mod: 15-29
Severe: more than 30

AHI is number of apneic episodes divided by number hours slept

171
Q

Diseases linked with malignant hyperthermia

A

Central core disease
King Denborough disease
Multi-mini core disease

172
Q

When does separation anxiety begin to manifest in infants?

A

6-8 mos

173
Q

Barbiturate used for ECT. Why?

A

Methohexitol—it doesn’t increase the seizure threshold or decrease seizure duration

174
Q

Cardiac resynchronization therapy is indicated if what criteria are met?

A 
All of the following should be present:
Sinus rhythm
EF 35 or less
NYHA class 2-4
QRS 150 or greater
LBBB
175
Q

Coag factors that decrease during pregnancy?

A

XI and XIII, C and S

176
Q

Mivacurium metabolism

A

Pseudocholinesterase

177
Q

Clotting factors that are increased in liver disease?

A

8 and vWF. Everything else is decreased.

178
Q

Name the anti-dopaminergics

A

Droperidol
Metoclopramide
Prochlorperazine

179
Q

Treatment methemoglobinemia

A

Methylene blue

Unless pt has g6pd deficiency, then ascorbic acid

180
Q

Max recommended dose of neostigmine

A

0.07 mg/kg

181
Q

List the GP IIb IIIa inhibitors. What do they do?

A

Tirofiban
Eptifibatide
Abciximab
They prevent platelet aggregation and thus thrombus formation

182
Q

List ADP inhibitors.

What do they do?

A

Clopidogrel, prasugrel, ticagrelor

They impair ADP-dependent activation of the GP IIb IIIa complex

183
Q

Definition ED95

A

Effective dose required to achieve 95% effect in 50% of the population

Anesthesia (14 decks)

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