ITE CA2 General 2 Flashcards
Arterial blood gas analysis directly measures …
Arterial blood gas analysis directly measures pH, PaCO2, and PaO2.
Most common lab finding in DIC
Thrombocytopenia is the most common laboratory diagnostic feature of DIC
Nerve palsies from LMA
Risk factors
Lingual nerve, recurrent laryngeal nerve, and hypoglossal nerve palsies have been reported following LMA use. Risk factors include overinflation of a small-fitting cuff, prolonged operative times (>2-4 hours), lidocaine lubrication, difficult insertion, use of nitrous oxide, and cervical joint disease.
Infective endocarditis prophylaxis when?
Infective endocarditis prophylaxis is recommended for cardiac conditions listed below PLUS:
1) Dental (mucosal, gingival) procedures or
2) Respiratory tract (tonsillectomy, adenoidectomy, bronchoscopy with incision/biopsy) procedures or
3) Infected skin/musculoskeletal tissue procedures
High risk cardiac conditions:
1) Prosthetic cardiac valve or prosthetic material used in valve repair
2) Previous endocarditis
3) CHD only in the following categories:
- Unrepaired cyanotic congenital heart disease
- Completely repaired congenital heart disease with prosthetic material or device within six months
- Repaired congenital heart disease with residual defects
4) Cardiac transplantation recipients with cardiac valvular disease
Infective endocarditis prophylaxis is NOT recommended for:
1) Routine/simple dental procedures without infected tissue
2) Gastrointestinal/Genitourinary procedures
3) Bronchoscopy without mucosal incision
4) Mitral valve prolapse, HOCM, bicuspid aortic valve
Smoking cessation benefits timeline
Twelve to 24 hours is enough to decrease carboxyhemoglobin levels and shift the dissociation curve rightward (increasing oxygen availability to tissues).
2-4 weeks improved mucociliary function
2-3 weeks increased sputum production
3-4 weeks decreased sputum production
6-8 weeks improved pulmonary immune function and normalization of hepatic enzyme activity
abstinence of at least 3 to 4 weeks reduced wound healing complications.
Apnea hypopnea index categories for OSA
Normal: AHI<5
Mild sleep apnea: 5≤AHI<15
Moderate sleep apnea: 15≤AHI<30
Severe sleep apnea: AHI≥30
organism for Croup
parainfluenza
organisms for epiglottitis
H influenza B
S pneumoniae
S Aureas
STOP BANG
Snoring Tired Observed Pressure BMI > 35 Age > 50 Neck > 17in or 43cm male or >16/41 female Gender (Male worse)
The jaw-thrust maneuver relieves upper airway obstruction by
The jaw-thrust maneuver relieves upper airway obstruction by providing anterior movement of the mandible and tongue. The genioglossus muscle is the attachment point of the tongue to the mandible.
The ____ muscle is the attachment point of the tongue to the mandible.
The genioglossus muscle is the attachment point of the tongue to the mandible.
symptoms of carcinoid syndrome can include:
symptoms of carcinoid syndrome can include: flushing, tachycardia, arrhythmias, diarrhea, malnutrition, bronchospasm, and potential for carcinoid heart disease (specifically right-sided).
O2 consumption in an adult
3-4 ml/kg/min
FRC estimate
30 ml/kg
Upright to supine reduction in FRC
10-15%
Reduction of FRC with induction of GA
10%
Things that increase MAC requirements
Hyperthermia, hypernatremia, chronic ethanol abuse, and increased central neurotransmitter levels (e.g. MAOIs, amphetamine, cocaine, ephedrine, and levodopa use) increase MAC requirements for anesthetic agents.
Things that decrease MAC requirements
Many factors decrease the MAC of anesthetic agents including acute ethanol ingestion, pregnancy, metabolic acidosis, and hyponatremia. Other factors include increasing age (especially > 40), hypoxia, hypothermia, induced hypotension, anemia, and certain drugs including α-2 agonists, lithium, large doses of cholinesterase inhibitors, lidocaine, opioids, barbiturates, and calcium channel blockers.
What is thought to be cause of ischemia reperfusion injury during liver transplant surgery?
When the blood supply to the liver is altered, inadequate oxygen and nutrients are supplied to the liver. Once the blood flow is reestablished, reperfusion enhances the injury caused during the ischemic period, aggravating the damage caused at the cellular level. This is known as ischemia-reperfusion injury and is thought to be caused by disruption of the sodium potassium pumps secondary to decreased adenosine triphosphate and glycogen.
Pseudocholinesterase deficiency prolongs the actions of what neuromuscular blockers
Pseudocholinesterase deficiency prolongs the actions of succinylcholine and mivacurium which can lead to prolonged neuromuscular blockade and apnea.
What drug can prolong sux action
Echothiophate is an anticholinesterase used to treat refractory glaucoma by causing miosis. Since it inhibits BCHE (butyrylcholinesterase), systemic absorption can cause up to a 95% decrease in BCHE function, thereby potentiating the effects of succinylcholine.
Other names for pseudocholinesterase
Butyrylcholinesterase (alternately pseudocholinesterase or plasma cholinesterase)
Genetic variants of psedocholinesterase deficiency
Approximately 20 genetic variants of the BCHE gene exist with the A- and K-variants being the most common.
Indications for hyperbaric oxygen therapy
air embolism, decompression sickness, poisoning, envenomation, soft tissue necrotizing infections refractory chronic osteomyelitis intracranial abscess mucormycosis crush injury compromised skin flaps central retinal artery/vein occlusion ischemia ulcers radiation necrosis oxygenation support during tehrapeutic lung lavage, significant blood loss anemia if transfusion delayed/unavailable burns
11 non-reassuring findings for predictors of difficult airway
The 11 non-reassuring findings are:
1) Relatively long incisors
2) Prominent “overbite”
3) Patient cannot bring mandibular incisors anterior to maxillary incisors
4) Less than 3 cm interincisor distance
5) Uvula is not visible when tongue is protruded with patient in sitting position
6) Highly arched or very narrow palate
7) Mandibular space that is stiff, indurated or occupied by a mass
8) Less than three ordinary finger breadth thyromental distance
9) Short neck length
10) Thick neck circumference
11) Decreased extension or flexion of the neck
Definition of difficult intubation
The American Society of Anesthesiologists defines difficult endotracheal intubation as three attempts at endotracheal intubation that takes ten or more minutes.
Patient with preop acute viral hepatitis
If a patient has acute preoperative viral hepatitis, surgery should not proceed unless deemed an emergency since the risk of morbidity and mortality is significantly elevated in these patients.
MH stuff in surgery center?
Medications, protocols, and equipment for malignant hyperthermia are only needed in office-based anesthesia in centers that use triggering agents such as succinylcholine or volatile anesthetics.
How prevent arrhythmia with extracorporeal shock wave lithotripsy
Immersion extracorporeal shock wave lithotripsy ESWL is performed by passing external shocks through the patient to break up renal calculi. The best way to prevent dysrhythmias is by synchronization of the shock to the R wave on the ECG.
Residents who developed substance use disorder were …
Residents who developed substance use disorder were more likely to be male, American medical graduates, and have lower ITE scores at the end of CA-1 year.
% of residence with e/o addiction during training
% of those who died during training
% who relapse w/i 30 years
% of those who relapse with death as presenting manifestation of relapse
- 0.86% of residents had evidence of addiction during training
- 7.3% of those died during the training period
- There is a 43% cumulative proportion of relapse at 30 years after the initial episode
- In 13% of those who relapsed, death was the presenting manifestation of relapse
Risk factors for determining postoperative hepatic dysfunction
The type of surgery (CT is worst) is most likely the biggest risk factor in determining whether postoperative hepatic dysfunction will occur. Following that is the presence of acute or chronic hepatitis and cirrhosis.
stridor 24-96 hours after thyroidectomy
Hypocalcemia occurs in approximately 20% of patients undergoing total thyroidectomy and develops 24-96 hours after surgery. Stridor can be a sign of hypocalcemia, and should be treated with IV calcium.
first line vasopressor in septic shock
Norepinephrine is the first-line vasopressor for treatment of septic shock after adequate intravascular volume expansion.
Lab tests in antiphospholipid syndrome
and why
Prothrombin time is typically normal, however, activated partial thromboplastin time (aPTT) may be elevated in antiphospholipid syndrome.
The elevated aPTT results from an inhibitor directed against phospholipid rather than specific coagulation factors.
Antiphospholipid syndrome
what is it
what causes it
is there a bleeding tendency?
Antiphospholipid syndrome is a prothrombotic disorder resulting in both venous and arterial thrombosis.
It is characterized by the presence of two autoantibodies, lupus anticoagulant and anticardiolipin antibody. Lupus anticoagulant has no true anticoagulant activity; instead, the anticoagulant activity is a laboratory artifact that affects the phospholipid-dependent coagulation assays. In the absence of an underlying coagulation deficit or anticoagulant therapy, the prolonged aPTT does not suggest a bleeding tendency and neuraxial anesthesia may be administered in this setting.
Down syndrome associations
Down syndrome patients frequently have cardiovascular defects (40-50%). The most common of these is endocardial cushion defects. Down syndrome is associated with atlantoaxial instability, hypotonia, and gastrointestinal, genitourinary, respiratory, vascular, and metabolic defects.
Muscle relaxant requirements in down syndrome
Down syndrome is associated with decreased, not increased, muscle relaxant requirement. These patients often present with hypotonia and require less muscle relaxants.
Allergies ass’d with latex allergy
Health care workers, children with spina bifida and urogenital syndromes, and people with allergies to banana, avocado, kiwi, pineapple, mango, and other tropical fruits have an increased risk for development of a latex allergy.
frequent cosmetic use ass’d with allergy to what drug
Frequent cosmetic use may be related to antibodies against aminosteroid NMBDs (pancuronium, pipercurium, rocuronium, and vecuronium), but there is no increased association with a latex allergy.
