ITE QBANK Misc 2 Flashcards
Common side effects of Zofran
- QTc prolongation (20%)
- Headache (11%)
- Transient inc in AST and ALT (5%)
- Constipation (4%)
In ECHOs, dP/dt is the _,
E/A is the _
dP/dt: rate of rise in ventricular pressure
- good measure of cardiac contractility
- Estimated using simplified bernoulli eq.
E/A: diastolic mreasurement
Majority of pts with myelomeningocele (spina bifida), where meninges and spinal cord are exposed, also have concommitant ___
Chiari II malformation (herniation of brainstem thru foramen magnum) and hydrocephalus secondary to blockage of fourth ventricle
- freq require VP shunt placement
Oxygen consumption in an adult is ~ __ mL/kg/min
and FRC is _ mL/kg.
How do you calculate min until hypoxemia?
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)
FRC is reduced by _% when going upright to supine and _% with induction of GA
15%
10%
*If pt obese, FRC is even more reduced and they desat faster.
How should congenital diagphragmatic hernia be managed to prevent worsening of pulmonary HTN?
- Low tidal volume ventilation
- Permissive hypercapnia (PaCO2 up to 65)
- Normothermia
Ketamine MOA
NMDA receptor antagonist - receptors are a class of excitatory glutamate receptors
Etomidate and propofol MOA
GABA agonist
Etomidate adverse events
- Burning on injection
- Post op nausea
- Superficial thrombophlebitis
Acute Intermittent Porphyria
- What is it
- preop treatment?
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
How does uremia (ie; a pt not having dialysis for several days) affect clotting?
Uremia causes impaired platelet production, function, and aggregation
- Interferes with vWF formation and release -> impaired platelet activation
- Abnl GPIIb-IIIa function on surface of platelets -> impaired platelet activation and aggregation
- Prostacyclin and NO is increased -> platelet inhibitory effects
- Decreased Tissue Factor -> cannot activate factor X -> cannot convert prothrombin to thrombin
Which one has higher risk of pneumothorax, supraclavicular or infraclavicular blocks?
Supraclavicular
- “do it all block”
- “spinal of the arm”
- Nerves are closely packed and readily blocked
1-6% risk of PTX
Which block is associated with:
- ipsilateral phrenic nerve and recurrent laryngeal nerve blockade
- ulnar nerve (C8-T1) sparing
- vertebral artery puncture
- Horner’s syndrome
Interscalene brachial plexus block
Most common complication of supraclavicular nerve block?
phrenic nerve blockade
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 ______.
Intrinsic and final coagulation pathways
XII, XI, IX, or VIII
Things that result in variable ACT during coagulation in cardiac cases
- Hemodilution
- Hypothermia
- Platelet count < 50
- Concomitant admin of meds (Prostaglandin, ASA, glycoprotein IIb/IIIa inhibitors)
Systemic Vascular Resistance (SVR) equation
SVR = 80 * (MAP - RAP) / CO
*R = R atrial P
Options for analgesia for stage II of labor
- Pudendal block
- Neuraxial anesthesia
- IV anesthesia (nitrous oxide)
Labor pains during the first stage of labor primarily arises from __, and is felt in __ dermatomes
uterus and cervix
- (visceral pain - Paracervical and hypogastric plexus)
T10-L1
Labor pains during the second stage of labor primarily arises from __, and is felt in __ dermatomes
perineum and vaginal stretch
- (Hypogastric plexus and pudendal nerve)
T12-L1 and S2-S4
Remifentanil is metabolized by ___ and has a half life of ___
plasma esterases
- not the liver
1-20 min
GCS Score
Eye
Verbal
Motor
Eye 4
Verbal 5
Motor 6
Where are these sweat glands found? What type of postsynaptic receptors are found at these sites?
- Eccrine
- Apocrine
Eccrine: Everywhere (except lips, tips of penis and clit)
- cholinergic
Apocrine: Armpits and perineum
- Adrenergic
A sudden (Increase/Decrease) in EtCO2 and SpO2 after tourniquet release should raise suspicion for PE from preop DVT
Decrease
*normally, EtCO2 is acutely Increased after