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Anesthesia based on Nebuchanedzzer II > ITE Gen Clin Sciences > Flashcards

ITE Gen Clin Sciences Flashcards

1
Q

Medically direct vs Medically supervised billing

A

Medically direct:

  • preop exam
  • induction and emergence
  • monitor course
  • physically present and available for immediate needs
  • Doesn’t need to be the same physician

Medically supervised: lower pay

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2
Q

Doubling the distance from a radiation source decreases exposure to ____ of the original

A

1/4

Intensity = 1/(r^2)

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3
Q

Why does nitrous oxide accumulate in closed spaces?

A

It is 30x more soluble than nitrogen.

Nitrous oxide will leave the blood, entering closed space much faster than nitrogen can leave that closed space back to the blood.

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4
Q

What is most rapidly expanded if nitrous oxide is used,

  • tension pneumothorax
  • expansion of venous air emboli
  • penumocephalus
  • intravitreal gas bubbles
A

pneumothorax

- can double in 10 minutes

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5
Q

Why is use of nitrous oxide in pts with intestinal obstruction avoided?

A

risk of expansion of air in lumen and w/in bowel

  • expansion of mucosa -> ischemia/infarcation
  • intestinal rupture
  • unable to close abdomen
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6
Q

What is more sensitive to detect VAE, Precordial doppler or PAC? What are its limitations?

A

Precordial doppler

- difficult in obese pts

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7
Q

_______ drugs cause extrapyramidal symptoms, especially in chronic, high doses, or simultaneous fashion. It can be treated with _______ meds.

A

Antidopaminergic drugs

Anticholinergic

  • benztropine
  • diphenhydramine
  • atropine
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8
Q

Latex allergies results in the development of _____ antibodies against _____. People with fruit allergies often have _____.

A

IgE antibodies

Latex antigens

Antibodies that cross-react with latex

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9
Q

Carbon monoxide poisoning shifts the hgb-oxygen dissociation curve to the (right/left).

A

Left

  • inhibits oxygen unloading from blood to tissues.
  • hgb binds CO with a 200x affinity than O2
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10
Q

Hyperbaric oxygen therapy is reserved for pts with ___ (4)

A
  1. neuro involvement
  2. cardiac abnormalities
  3. HbCO > 25%
  4. Pregnancy
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11
Q

____ in the best indicator of liver transplant graft function

A

INR
- elevated = good liver func

Other nonspecific liver labs:
AST: muscle injury
Albumin: poor nutrition
Bilirubin: GI bleeding or hemolysis
GGT or Alk phos: biliary issues
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12
Q

Lung volume at which small airways begin to close

A

closing capacity

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13
Q

When closing capacity surpasses FRC, ____ increases and _____ decreases

A

shunt

oxygenation

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14
Q

The ____ score replaced the _____ score for prioritization of pts for liver transplant

A

MELD

Child-Pugh

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15
Q

Mneumonic for MELD scoring for liver transplant

A

I Crush Several Beers Daily

  • INR
  • Cr
  • Sodium
  • Bilirubin
  • Dialysis
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16
Q

neuroleptic malignant syndrome occurs in pts taking _____.

A

antipsychotics

  • 1st gen: haloperidol
  • New atypical
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17
Q

Implications of decreased beta-receptor responsiveness in elderly patients

A

Limited compensatory response to stress

- If pt becomes hypotensive, they can no longer increase chronotropy, inotropy, and SVR

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18
Q

Ach release is (increased/decreased) with age in response to vagal stimulation

A

decreased

- decreased parasympathetic nervous system activity

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19
Q

Intercostobrachial nerve arises from ___ nerve root and supplies _______.
It is not blocked by any of the brachial plexus nerve blocks (supraclav, infraclav, interscalene, axillary n)

A

T2

Medial/posterior upper arm

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20
Q

_______ nerve is a branch of the musculocutaneous n, and provides innervation to the lateral half of the forearm.

A

Lateral antebrachial cutaneous

- C5-C6 nerve root

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21
Q

_______ nerve is a branch of the musculocutaneous n, and provides innervation to the medial half of the forearm.

A

medial antebrachial cutaneous n.

- C8-T1

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22
Q

_______ nerve provides innervation to the medial half of the hand

A

Ulnar

- C8-T1

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23
Q

_______ nerve provides innervation to the medial half of the hand

A

Median

- C5-C8

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24
Q

______ is the most common cause of an acute change in peak airway pressures and desaturation when a bronchial blocker is used for one-lung ventilation

A

Dislodgement of the bronchial blocker

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25
Q

When is Bronchospasm (inc peak airway P and desat) most typical?

A

During induction and emergence

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26
Q

How does a tension pneumo look in the OR?

A

Hypotension
Desaturation
Gradual inc in peak airway pressures

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27
Q

What is MH and Why are calcium channel blockers contraindicated in malignant hyperthermia when being treated by dantrolene?

A

MH: Ryanodine receptor defect - prolonged opening of channel - hypermetabolic state

Dantrolene has synergistic effect with CCB and decreases release of calcium from SR ->

  • Arrhythmias
  • Myocardial depression
  • HyperK
  • CV collapse
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28
Q

Each 20mg vial of dantrolene contains ___ g of mannitol

A

3g

- helps maintain u/o

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29
Q

Meralgia paresthetica is ____ and is d/t compression/stretch injury of the nerve as it passes around the anterior superior iliac spine through the inguinal ligament

A

a mononeuropathy of the lateral femoral cutaneous nerve
- pure sensory

*common in pregnancy

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30
Q

Brachial plexus injury can occur in open heart surgery (sternotomy) secondary to _____

A

sternal retractor use

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31
Q

Meperidine’s active metabolite is normeperidine, which is excreted by the kidneys. Accumulation of it is ______

A

neurotoxic and can cause seizures

*caution in pts with renal dysfunction

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32
Q

Morphine’s active metabolite is morphine-6-glucuronide, which is excreted by the kidneys. Accumulation of it is ___

A

known to cause sig respiratory depression

*caution in pts with renal dysfunction

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33
Q

Why does meperidine often have tachycardia as a common side effect?

A

molecule resembles atropine

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34
Q

Glycopyrrolate is an _____ drug that works mainly at ____ receptors.

A

Anticholinergic

  • competitive antagonist of acetylcholine
  • blocks parasympathetic effects of cholinergic surg

Muscarinic

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35
Q

What happens if you block muscarinic receptors on the heart?

A

Receptors loc at SA node
-> block = tachycardia

*Glycopyrrolate and atropine and Scopolamine is an anticholinergic

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36
Q

What happens if you block muscarinic receptors on the airway mucosa and bronchi?

A

Inhibits salivation and respiratory secretion

Also leads to bronchial muscle relaxation

*Glycopyrrolate and atropine is an anticholinergic

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37
Q

What happens if you block muscarinic receptors on the GI system?

A

decrease gastric motility and peristalsis -> constipation

*Glycopyrrolate and atropine is an anticholinergic

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38
Q

What happens if you block muscarinic receptors on the GU system?

A

Urinary retention

*Glycopyrrolate and atropine is an anticholinergic

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39
Q

What happens if you block muscarinic receptors on the Ophthalmic system?

A

pupillary dilation and photophobia

*Glycopyrrolate and atropine is an anticholinergic

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40
Q

What happens if you block muscarinic receptors on the neurologic system?

A

Glycopyrrolate does NOT cross BBB: no effect

Atropine and scopolamine: AMS and hallucinations

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41
Q

Symptoms seen with cholinergics

A 
SLUDGE-Mi
Salivation
Lacrimation
Urination
Defecation
GI upset
Emesis
Miosis

*Glycopyrrolate and atropine is an anticholinergic and has opposite effects

42
Q

VOlume control ventilation delivers mechanical breath at a constant ____ until the set volume of air is delivered.

A

flow rate

43
Q

FRC (increases/decreases) as you age

A

Increases
- however, Residual volume increases at a faster rate than ERV –>
effectively decreases oxygen reserves in presence of apnea

*note: closing capacity surpasses FRC with age

44
Q

______ is responsible for increased small airway collapse in elderly population

A

Closing capacity

45
Q

Which inhalational gas can inhibit DNA synthesis?

A

N2O - nitrous oxide

- inhibits tetrahydrofolate, which is req for DNA synthesis

46
Q

Vomiting leads to (increase/decrease) in HCO3-

A

increase

  • loss of HCl
  • metabolic alkalosis
47
Q

How does acupuncture help PONV?

A

stimulation of the P6 point (inner wrist)

- cochrane review

48
Q

(True/False) diuretics can be used for both TACO and TRALI

A

False - only TACO

- circulatory overload

49
Q

Higher blood:gas partition coefficients (or blood solubility) corresponds with:
(greater/lesser) degrees of volatile agent uptake, and thus, (faster/slower) onset of action.

A

Greater

Slower

*for example, Desflurane Blood:Gas partition coefficient is 0.42 and Isoflurane is 1.5. Des has lower solubility, and faster uptake.

50
Q

Inhales agents with high Fa (alveolar concentration of an anesthetic) / FI (inspired concentration) value are associated with:
(higher/lower) blood solubility

A

lower

51
Q

Blood:Gas partition coefficient of:
Desflurane is ____
Sevoflurane is ____
Isoflurane is ___.

A
  1. 42
  2. 65
  3. 5
  • Des has lower solubility, and faster uptake.
52
Q

Higher blood:gas partition coefficients (or blood solubility) is associated with (higher/lower) FA/FI?

*Fa (alveolar concentration of an anesthetic) / FI (inspired concentration)

A

lower

53
Q

What is the most common cause of litigation during MAC?

A

1: Respiratory depression -> inadequate oxygenation/ventilation secondary to sedative/analgesic overdose

54
Q

Why is it safer for an adult to donate a liver to a child?

A

Children have smaller liver

  • Adults can donate L liver
  • Less technical (no biliary tree or major vessels)
  • Smaller liver resection
55
Q

Acute processes that cause a sudden drop in ETCO2 (4)

A

VAE
Large PE
Low cardiac output (CV collapse)
Kinked ETT or sampling line disconnect

56
Q

If pt had a massive venous air embolism in the OR what would you expect to see?

A

Drop in ETCO2

Increased end tidal nitrogen

57
Q

The most common cause of sudden increase in physiologic dead space (impaired or absent perfusion of alveoli enhancing V:Q mismatch) is _______

A

sudden drop in cardiac output

58
Q

Which reflex remains intact during GA?

A

Pupillary light response

- different from brain death

59
Q

What is one anesthesia time unit for billing?

A

15 min

60
Q

When to repeat an ECHO in a pt with mod-greater degree of valvular stenosis or regurgitation?

A

if no echo w/in 1 year

if significant physical exam change

61
Q

Severe Aortic stenosis is defined as valve area < than ___ cm2 and a transvalvular pressure gradient > than ____ mmHg

A

< 0.8 cm2

50 mmHg

62
Q

Goal HR for patients with aortic regurgitation?

A

> 80 bpm, increase diastolic time = less regurgitation time

63
Q

Goal preload and afterload for patients with aortic regurgitation?

A

adequate preload/volume -> ensure forward flow

low SVR -> prevent regurg

64
Q

2 most common reasons for discharge delay

A
  1. pain

2. PONV

65
Q

Post op, if serum bilirubin is elevated and the AST/ALT are not, the differential is _____

A
  1. Preexisting abnormality of bilirubin metabolism

2. Hemoglobin breakdown from hemolysis or hematoma reabsorption

66
Q

Post op, if both serum bilirubin and the AST/ALT is elevated, the differential is _____

A

Mild elevation:

  • Intrahepatic cholestasis
  • Extrahepatic biliary obstruction

Marked elevation”

  • severe hypotension -> hepatic ischemia
  • viral infection
  • drugs
67
Q

Management of:

  • Intrahepatic cholestasis
  • Extrahepatic biliary obstruction
A
  • Intrahepatic cholestasis: supportive. resolves spontaneously
  • Extrahepatic biliary obstruction: intervention depending if stricture or retained biliary stones
68
Q

Which anesthetic gas is assoc with hepatic dysfunction?

A

Halothane hepatitis

69
Q

Complications with brachial artery catheterization?

A

Thrombosis
Infection
Median n injury

70
Q

The axillary sheath the ____ nerves.

A

Median, ulnar, radial n

*Musculocutaneous is outside the sheath

71
Q

Brachial plexus root subdivisions mneumonic

A

Rugby Teams Drink Cold Beers

Roots (C5-T1)
Trunks (Superior, middle, inferior)
Divisions
Cords
Branches (msk, axillary, median, radial, ulnar n.)
72
Q

Latex allergies have ____ mediated antibody response

A

IgE - Type 1

- delayed onset 30 min

73
Q

Long thoracic n roots

A

Roots C5, C6, C7 - “wings to heaven”

74
Q

TPN can result in (immediate/delayed) postop jaundice

A

delayed

- TPN associated cholestasis

75
Q

Succinylcholine can increase intraocular pressure by ____ mmHg

A

10 mmHg

- in open globe injury, use roc - nondepolarizing NMB

76
Q

Why shouldnt you use ketamine for ocular procedures?

A

nyastagmus

increase in IOP

77
Q

If aspiration in the OR occurred and pt is stable, what do you do?

A 
Suction the ET
Supportive tx (abx not required - ie. bubbamoyer)
78
Q

Bone cement implantation syndrome is characterized by ______ after methyl methacrylate implantation

A

Hypoxia
Hypotension
Cardiac dysrhythmias
Increase pulmonary vascular resistance

79
Q

Brachial a. cannulation is most likely to injure which n?

A

Median n.

- immediately adjacent to brachial a.

80
Q

Diff btwn mallampati II and III?

A

II: base of uvula and upper uvula, fauces

III: base of uvula only

81
Q

Mediastinoscopy involves the videoscope being passed _______ and lifting the scope can cause compression and loss of a-line wave.

A

posterior to the Brachiocephalic artery

82
Q

Treatment for extravasation of vasoconstrictor (ie: phenylephrine)

A

Sub Q phentolamine or hyaluronidase

83
Q

Indications for hyperbaric oxygen therapy? (6)

A
  1. Gas bubble disease
  2. Poisoning (venom, CO, cyanide)
  3. Infections (necrotizing, refractory osteo, intracranial abscess, mucormycosis)
  4. Acute/Chronic ischemia
  5. ACUTE hypoxia (not chronic)
  6. Burn injury
84
Q

_____ lab value is the best determinant of synthetic liver function

A

PT/INR

*PT is often elevated 1.5x normal if severe liver disease is present

*mneumonic is WEPT
Warfarin
Extrinsic
PT

85
Q

The ____ supplies 20% of the blood to the liver, and the ____ supplies 80%

A

Hepatic artery

Portal vein

86
Q

PT can be prolonged by _____

A

anticoagulants
Vit K deficiency
liver disease

87
Q

Albumin has a half life of ___ days. Normal level is ___ g/dL

A

20

4g/dL

88
Q

PTT measures the clotting time of the _____ and common pathway of coagulation

A

Intrinsic and common pathway

89
Q

PT measures clotting time of the ______ and common pathways of coagulation

A

extrinsic (factor VII)

*mneumonic is WEPT
Warfarin
Extrinsic
PT

90
Q

The ______ test is the gold std for diagnosis of malignant hyperthermia and tests for RYR1 gene mutation.

A

Halothane-caffeine contracture

91
Q

Volume status is most accurate with measurement with ______.
_____ suggests fluid responsiveness

A

arterial pressure variation (PVV or SVV)

- SVV > 13% = suggests fluid responsiveness

92
Q

Are status measures such as central venous pressure (CVP) and pulmonary artery occlusion pressure adequate indicators of volume status?

A

No
- dynamic measurements like pulse pressure variations (PVV) and stroke volume variations (SVV) are sensitive and specific indicators

93
Q

Basic principle of arterial pressure variation (SVV or PPV)

A

stroke volume varies much more significantly with respiration in the presence of hypovolemia

94
Q

If a pt meets at least 3 of the RCRI risk factors, he meets class IIb indication for ______ initiation ___ days before surgery

A

beta blocker
2-45 days BEFORE

*BB have cardioprotective effects, reduce HR and contractility -> lowers myocardial oxygen demand

95
Q

(True/False) most HBV infections progress to chronic carrier status

A

False

- 90% do NOT progress to chronic HBV carrier

96
Q

Primary prophylaxis against HBV following blood or bodily fluid exposure to HBV

A

HBV hyperimmune globuline

HBV vaccine should also be given

97
Q

The efferent branch of the laryngospasm reflex is mediated by _____

A

recurrent laryngeal n.

- motor innervation

98
Q

the ______ n is responsible for sensory innervation of the posterior 1/3 of the tongue

A

Glossopharyngeal n

99
Q

The afferent branch of the laryngospasm reflex is mediated by _____

A

internal branch of the superior laryngeal n.

- sensory innervation of the trachea at and above level of vocal cords

100
Q

Laryngospasm is a reflex that occurs when the _____ n. is stimulated, causing a reflex closure of the vocal cords with the motor innervation by the ______ n.

A

Superior laryngeal n

Recurrent laryngeal n

Anesthesia based on Nebuchanedzzer II (38 decks)

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