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Anesthesia based on Nebuchanedzzer II > ITE QBANK Misc 2 > Flashcards

ITE QBANK Misc 2 Flashcards

1
Q

Common side effects of Zofran

A
  1. QTc prolongation (20%)
  2. Headache (11%)
  3. Transient inc in AST and ALT (5%)
  4. Constipation (4%)
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2
Q

In ECHOs, dP/dt is the _,

E/A is the _

A

dP/dt: rate of rise in ventricular pressure

  • good measure of cardiac contractility
  • Estimated using simplified bernoulli eq.

E/A: diastolic mreasurement

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3
Q

Majority of pts with myelomeningocele (spina bifida), where meninges and spinal cord are exposed, also have concommitant ___

A

Chiari II malformation (herniation of brainstem thru foramen magnum) and hydrocephalus secondary to blockage of fourth ventricle
- freq require VP shunt placement

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4
Q

Oxygen consumption in an adult is ~ __ mL/kg/min
and FRC is _ mL/kg.

How do you calculate min until hypoxemia?

A

3-4 mL/kg/min

30 mL/kg

*multiply above by pts body weight (kg) to get O2 consumption and FRC

Min until hypoxemia = (FRC/O2 consumption)

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5
Q

FRC is reduced by _% when going upright to supine and _% with induction of GA

A

15%

10%

*If pt obese, FRC is even more reduced and they desat faster.

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6
Q

How should congenital diagphragmatic hernia be managed to prevent worsening of pulmonary HTN?

A
  1. Low tidal volume ventilation
  2. Permissive hypercapnia (PaCO2 up to 65)
  3. Normothermia
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7
Q

Ketamine MOA

A 
NMDA receptor antagonist
- receptors are a class of excitatory glutamate receptors
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8
Q

Etomidate and propofol MOA

A

GABA agonist

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9
Q

Etomidate adverse events

A
  1. Burning on injection
  2. Post op nausea
  3. Superficial thrombophlebitis
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10
Q

Acute Intermittent Porphyria

  • What is it
  • preop treatment?
A

AIP: deficiency in enzyme required for heme synthesis
- 4 types

IV fluids + GLucose (avoid starvation states)
Avoid exacerbating attack
- Avoid: barbiturates, sulfonamides, ethyl alcohol, ergotamine

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11
Q

How does uremia (ie; a pt not having dialysis for several days) affect clotting?

A

Uremia causes impaired platelet production, function, and aggregation

  1. Interferes with vWF formation and release -> impaired platelet activation
  2. Abnl GPIIb-IIIa function on surface of platelets -> impaired platelet activation and aggregation
  3. Prostacyclin and NO is increased -> platelet inhibitory effects
  4. Decreased Tissue Factor -> cannot activate factor X -> cannot convert prothrombin to thrombin
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12
Q

Which one has higher risk of pneumothorax, supraclavicular or infraclavicular blocks?

A

Supraclavicular

  • “do it all block”
  • “spinal of the arm”
  • Nerves are closely packed and readily blocked

1-6% risk of PTX

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13
Q

Which block is associated with:

  • ipsilateral phrenic nerve and recurrent laryngeal nerve blockade
  • ulnar nerve (C8-T1) sparing
  • vertebral artery puncture
  • Horner’s syndrome
A

Interscalene brachial plexus block

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14
Q

Most common complication of supraclavicular nerve block?

A

phrenic nerve blockade

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15
Q

PTT tests the integrity of the ______ pathways and is more sensitive to lower levels of heparin than ACT. PTT will be prolonged when there are deficiencies in factors ______.

A

Intrinsic and final coagulation pathways

XII, XI, IX, or VIII

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16
Q

Things that result in variable ACT during coagulation in cardiac cases

A
  1. Hemodilution
  2. Hypothermia
  3. Platelet count < 50
  4. Concomitant admin of meds (Prostaglandin, ASA, glycoprotein IIb/IIIa inhibitors)
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17
Q

Systemic Vascular Resistance (SVR) equation

A

SVR = 80 * (MAP - RAP) / CO

*R = R atrial P

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18
Q

Options for analgesia for stage II of labor

A
  1. Pudendal block
  2. Neuraxial anesthesia
  3. IV anesthesia (nitrous oxide)
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19
Q

Labor pains during the first stage of labor primarily arises from __, and is felt in __ dermatomes

A

uterus and cervix
- (visceral pain - Paracervical and hypogastric plexus)

T10-L1

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20
Q

Labor pains during the second stage of labor primarily arises from __, and is felt in __ dermatomes

A

perineum and vaginal stretch
- (Hypogastric plexus and pudendal nerve)

T12-L1 and S2-S4

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21
Q

Remifentanil is metabolized by ___ and has a half life of ___

A

plasma esterases
- not the liver

1-20 min

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22
Q

GCS Score
Eye
Verbal
Motor

A

Eye 4
Verbal 5
Motor 6

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23
Q

Where are these sweat glands found? What type of postsynaptic receptors are found at these sites?

  • Eccrine
  • Apocrine
A

Eccrine: Everywhere (except lips, tips of penis and clit)
- cholinergic

Apocrine: Armpits and perineum
- Adrenergic

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24
Q

A sudden (Increase/Decrease) in EtCO2 and SpO2 after tourniquet release should raise suspicion for PE from preop DVT

A

Decrease

*normally, EtCO2 is acutely Increased after

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25
Q

Propofol infusion syndrome

A

rare complication of high dose (>4 mg/k/hr or > 65 mcg/kg/min), long term (>24h) propofol infusion

Prop impairs cellular FFA utilization and mitochondrial activity -> inc reliance on anaerobic metabolism
- Cardiac and skeletal m and pancreas particularly susceptible to dmg

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26
Q

Multifocal atrial tachycardia (MAT) defined by HR > 100 and 3 or more diff P waves
- Most likely associated with pts with ___

A

Pulmonary (COPD exacerbation, pulm HTN) and cardiac pathology (atrial distention)

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27
Q

The lungs play a significant role in the metabolism of multiple hormones
- Which ones does it activate?

A

Angiotensin I

Arachidonic acid

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28
Q

The lungs play a significant role in the metabolism of multiple hormones
- Which ones does it inactivate? (8)

A
  1. Adenosine
  2. ATP
    3, Bradykinin
  3. Endothelin
  4. Leukotrienes
  5. Norepi
  6. PGD, PGE, PGF
  7. Serotonin
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29
Q

The lungs play a significant role in the metabolism of multiple hormones
- Which ones does it not affect? (7)

A
  1. Angiotensin II
  2. Dopamine
  3. Epi
  4. Histamine
  5. Oxytocin
  6. PGI2 and PGA2
  7. Vasopressin
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30
Q

Perioperative conditions leading to sickling

A

SIX H’s cause SICKling (HbS)

  1. Hypothermia
  2. Hyperthermia
  3. Hypoxemia
  4. Hypotension
  5. Hypovolemia
  6. H+ ions (acidosis)

*HTN does NOT cause sickling

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31
Q

Altered mental status
Non pitting edema
Hypothermia

A

Myxedema Coma

  • Pitting edema from mucin deposit in the skin
  • Life threatening - mortality rate of 30-60%
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32
Q 
SIADH (Euvolemic Hyponatremia)
Urine Osmolality?
FENa?
Ur Na+?
Serum Uric acid and BUN?
A

Ur Osm: > 100 mOsm

FENa: >1%

Ur Na+: >20 mEq

Low serum Uric acid and BUN

  • *Elevated ADH = concentrated urine
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33
Q

Elevated ADH (SIADH), (Promotes/Prevents) diuresis but PERMITS natriuresis and other solutes

A

prevents

  • *Elevated ADH = concentrated urine
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34
Q

SIADH is a _______, ________ hyponatremia

A

dilutional, euvolemic

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35
Q

Fenoldopam is a ______ receptor agonist with direct _____ and _____ properties

A

Selective dopamine (D1) receptor agonist

Natriuretic

Diuretic

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36
Q

Large molecules (are/are not) able to pass through the semipermeable membrane used for hemodialysis (HD).

Serum bicarb, Na, Glucose, protein concentrations (increase/decrease) following HD

A

Are NOT

Increase d/t concentrating effect

*HD uses ultrafiltration, only allows small molecules to cross.

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37
Q

Fenoldopam is a selective D1 receptor agonist that directly causes _______ vasodilation and produces ______ at higher doses

A

Renal vasodilator

Hypotension

*Renal protector when renal vasoconstriction is anticipated

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38
Q

Substances commonly removed from pts blood: (7)

A 
calcium
magnesium
phosphate
potassium
urea
creatinine
water
39
Q

Extracorporeal shock wave lithotripsy (ESWL) can cause dysrhythmias if shock travels through heart and disrupts nl conduction. The best way to prevent dysrhythmias is by synchronization of shock to the _____ wave on ECG

A

R wave (refractory period of cardiac cycle)

40
Q

Prerenal

  • FENa
  • BUN:Cr
A
  • FENa: <1

- BUN:Cr >20

41
Q

Intrinsic and Postrenal

  • FENa
  • BUN:Cr
A
  • FENa >2

- BUN:Cr < 20

42
Q

FENa < 1

A

Prerenal

43
Q

BUN:Cr > 20

A

Prerenal

44
Q

Large amts of blood products containing sodium citrate can lead to _______ as it can be metabolized into ________

A

metabolic alkalosis

sodium bicarbonate

45
Q

Peritoneal dialysis is the preferred dialysis mode for pts who cannot tolerate ___________

A

the hemodynamic challenges of hemodialysis

ie. unstable angina, severe AS, HFrEF

46
Q

Pts needing long term dialysis for ESRD usually get (peritoneal/traditional) hemodialysis

A

traditional

  • better clearance of solutes
  • better volume management
47
Q

Pts with autosomal dominant polycystic kidney disease should get _____ prior to robotic surgeries

A

CT angiogram of the head

  • d/t increased risk of intracranial aneurysms
  • Steep trendelenburg increases risk of cerebral aneurysm rupture
48
Q

Post-cardiopulmonary bypass AKI risk factors:

A
  1. Preop cr > 1.2
  2. Combined valve + bypass procedures
  3. emergency sx
  4. Pre-op intraaortic balloon pump
49
Q

Main sx of bladder perforation is _________. If TURP procedures are done under spinal anesthesia, it should be below the level of ___ to recognize CNS sx.

A

abdominal pain

T10

50
Q

___________ is the best perioperative test to predict AKI in the setting of suprarenal aortic cross-clamping for repair of ruptured abdominal aortic aneurysm

A

Creatinine clearance
- 24 hr ideal, but 2 hr collection reasonable

*BUN and Cr ideal to determine preexisting renal dmg and will not reflect failure until well established

51
Q

_________ and ________ helps prevent the remodeling that occurs secondary to angiotensin II and are beneficial in CHF

A

ACEi and ARBs

*remodeling: cardiomyocyte proliferation and fibroblast activity

52
Q

Kidneys receive __% of cardiac output.

Renal cortex gets ___% of cardiac output and has oxygen extraction ratio of __%.

Renal medulla gets __% of cardiac output and has oxygen extraction ratio of __%.

A

20%

Cortex: 95%, 20%

Medulla: 5%, 80%
- A small change in total blood flow to the kidney can has exaggerated effects in the medulla -> local hypoxia/injury

53
Q

(Hypervolemia/Hypovolemia) can increase risk of afib

A

both

Hypervolemia: mechanical stim of RA -> myocardial stretch -> increase atrial cell triggering

Hypovolemia: decrease venous return to RA -> reduce SV and CO -> dec tissue O2 delivery -> induce catecholamine release

54
Q

High amts of excess H+ ion in serum results in (Higher/Lower) free bicarbonate ion levels. This causes a _______ in pts w/ metabolic acidosis

A

Lower
- bicarb buffering effect

High anion gap
d/t loss of free bicarb ion

55
Q

Renal failure often causes _______ d/t the kidney’s inability to regulate extracellular fluid H+ ion [ ]

A

metabolic acidosis

*normal kidney fxn reabsorbs filtered bicarb, secretes H+ ions, and produces new bicarb ions

56
Q

Renal replacement therapy is a broad term that encompasses: (4)

A
  1. hemodialysis “dialysis”
  2. peritoneal dialysis
  3. hemofiltration
  4. renal transplantation
57
Q

Continuous Renal Replacement therapy includes: (3)

- The concept of CRRT is to dialyze slowly, over 24h, just like the kidney does

A
  1. Continuous venous hemodialysis (CVVHD)
  2. Continuous venous hemofiltration (CVVH)
  3. Continuous venous hemodiafiltration (CVVHDF)
58
Q

Newer irrigation solns used for TURP like glycine, cytal (mannitol and sorbitol) decrease the incidence of cerebral edema and hemolysis, but the incidence of _______ are unchanged

A

Hyponatremia and fluid overload

59
Q

Time of onset for local anesthetic systemic toxicity with CNS sx?

A

Immediately

60
Q

Steroid induced myopathy usually involves ______ muscles. Usually occurs after _____ weeks

A

proximal

3-4 weeks

61
Q

3 hormones that counteract the action of insulin (and increase hepatic gluconeogenesis)

A

Cortisol

Catecholamine

Glucagon

62
Q

SIRS is associated with (catabolism/anabolism) d/t increase in beta 2 adrenergic stimulation, and increased energy expenditures

A

Catabolism

- increase in lipolysis and proteolysis

63
Q

Exposure to ______ has the highest risk for seroconversion

A

Hep B surface antigen +
- 30-60%

*HIV and HCV is 0.3%

64
Q

Ventilator associated pneumonia is associated with a ____ times mortality in pts vs pts without it.
Abx?

A

5x

3 drug combo

  • Beta lactam/beta-lactamase inhibitor
  • Antipseudomonal FQ
  • Either Linezolid or Vanc
65
Q

______ is effective at reducing I-131 uptake by the thyroid and reduces the incidence of radiation exposure related thyroid complications

A

Potassium iodide

66
Q

________ is the treatment choice of methemoglobinemia in pts with G6PD deficiency by reducing ___ to ____

A

ascorbic acid

*reduces Fe3+ to Fe2+

67
Q

Methemoglobinemia occurs when hgb becomes ______ from Fe2+ to Fe3+.

A

oxidized

68
Q

Methemoglobin is unable to bind ____ and causes a funcational _____, it also shifts the oxygen dissociation curve to the ______

A

oxygen

anemia

Left shift

69
Q

______ can be used to treat cyanide toxicity, by oxidizing Fe2+ to Fe3+.

A

Amyl Nitrite

70
Q

_______ can all cause transient decreases in SpO2 lasting any where from ____ to ____ minutes

A

methylene blue

indocyanine green

indigo carmine

71
Q

Why is the R IJ central line more common than L?

A

Increased incidence of arterial puncture d/t more venous overlay over the artery

72
Q

Carotid embolization from carotid artery cannulation on the (Right/Left) poses greater risk as the (Right/Left) cerebral hemisphere is dominant in the majority of the population

A

Left

Left

*R sided carotid massage is preferred over L sided

73
Q

TPN is most associated with which two complications?

A 
#2 Thrombophlebitis 
#1 infection
74
Q

Acid-base status can be managed during cardiopulmonary bypass (CPB) by ____ and ____

A

pH-stat and alpha-stat

75
Q

There is a natural (Acidic/Alkaline) drift associated with hypothermia d/t the increase in gas solubility and reduction of the _____

A

Alkaline

PaCO2

76
Q

pH-stat corrects for the alkaline drift during CPB by maintaining _______.

A

neutral pH during hypothermia

*alpha-stat allows natural alkaline drift to occur

77
Q

Alpha-stat is able to maintain autoregulation and the embolic load to the brain is minimized through coupling ___ with ____

A

CBF and Cerebral metabolic rate of oxygen demand (CMRO2)

78
Q

Corticosteroid deficiency in the ICU is most likely secondary to ____

A

functional adrenal insufficiency (not primary)

79
Q

Abx used to treat GNB (ie: cefepime) can worsen hypotension by _______

A

directly lysing outer bacterial membrane, releasing Lipopolysaccharide (LPS)

80
Q

Theory of drowning is persistent _____ following aspiration of fluid

A

laryngospasm

81
Q

Mg is excreted by the (liver/kidney)

A

kidney

*pts with RF high risk of hypermag

82
Q

Theopylline is a methylxanthine drug similar to ____. Pt is at risk for ___ and ____ d/t preeclampsia and hypermagnesemia.

A

caffeine

sz and arrhythmias

83
Q

Magnesium potentiates ________ drugs and ________

A

nondepolarizing NMBs

Local anesthetics

84
Q

How much sodium bicarbonate should be administered to pts to correct a metabolic acidosis?

(Only if they are mechanically ventilated or else their respiratory acidosis will worsen!)

A

Sodium bicarbonate (mEq) = 0.2 * pt weight * base deficit

85
Q

Sodium bicarb should not be administered to a pt with respiratory depression or respiratory failure unless _________.

Sodium bicarb will be converted to ___ and if a respiratory compensation cannot occur, respiratory acidosis will worsen the acidosis

A

the pt is intubated

CO2

86
Q

Narrowest part of the pediatric airway?

A

GLOTTIC OPENING

87
Q

How are infants able to feed and breathe at same time?

A
  1. posteriorly displaced sphincter
  2. large omega shaped epiglottis
  3. cephalic position of the larynx
88
Q

2 (surface tension)
_____________
Radius

A

La place’s law

89
Q

What type of apnea is more assoc w/ preterm infants?

A

central apnea - immaturity of respiratory centers

90
Q

average o2 consumption in neonates and adults in ml/kg/min?

A

Neonate: 6.4 ml/kg/min

Adult: 3.5 ml/kg/min

91
Q

EMLA cream is made of ____ and _____

A

Lidocaine 2.5%

Prilocaine 2.5%

92
Q

age based formula for uncuffed ETT size

A

(age/4) + 4

*cuffed size is a half size off at the end

93
Q

What type of shock is seen with:

  • hypotension for > 30 min,
  • SBP < 90 mmHg
  • PCWP > 18 mmHg
  • Cardiac index < 2.2
A

cardiogenic shock

Anesthesia based on Nebuchanedzzer II (38 decks)

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