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Anesthesia 101 > ITE QBANK Misc 3 > Flashcards

ITE QBANK Misc 3 Flashcards

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1
Q

Early adult onset ventilator assoc. PNA is typically d/t _____

A

MSSA

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2
Q

TCAs primary MOA is the inhibition of presynaptic neurotransmitter uptake _______ and _______

A

Norepi and serotonin

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3
Q

Treatment for TCA toxicity with ECG showing wide QRS interval

A

Sodium bicarb

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4
Q

Common metabolic changes seen with TPN (6)

A
  1. Hypercarbia
  2. Hyperglycemia
  3. Hyperinsulinemia
  4. Hypophosphatemia
  5. Hypokalemia
  6. Hypomagnesemia

*NOT sodium

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5
Q

Can hepatic steatosis be seen in TPN?

A

Yes - common

- liver will store excess sugar as fat in liver

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6
Q

Can hypocarbia or hypocapnia occur with TPN infusion?

A

No - HYPERcarbia or HYPERcapnia

- Pt will metabolize excess carbs into sugar and increase CO2 production.

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7
Q

Can hypernatremia occur with TPN?

A

Unlikely

- more common in pts not receiving enough free water (calculate deficit and give as free water bolus)

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8
Q

Is low dose corticosteroids good for tx of septic shock?

A

No - not Recommended unless pt is unresponsive to fluids and vasopressors

No mortality benefit, but does reduce dependence of vasopressors and speed resolution of shock

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9
Q

____________ is defined as intrapulmonary vascular dilatations and increased A-a oxygen gradient, in the setting of end-stage liver disease

A

Hepatopulmonary syndrome

*Pts with hepatic failure have excessive circulating levels of NO –> excessive pulmonary vasodilators.

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10
Q

In hepatopulmonary syndrome, hypoxia is _____ when the pt lies flat, and ______ when the pt stands

A

Improved (platypnea)

worsened (orthodeoxia)

*worsened by increasing VP mismatch

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11
Q

Mean PAP > __ mmHg in a liver failure pt is suggestive of high perioperative mortality risk.

Mean PAP > __ mmHg is an absolute contraindication to liver transplantation.

A

> 35 mmHg

> 50 mmHg

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12
Q

Septic shock is a dyregulated response to infection, causing a metabolic _______ with compensatory ______

A

acidosis

respiratory alkalosis

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13
Q

Phosgene (chemical warfare agent) exposure can cause severe ________, which can cause significant morbidity and mortality

A

pulmonary edema

*targets type I and II pneumocytes

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14
Q

Inflammatory mediators cause:

  • Prostaglandin:
  • Bradykinin:
  • Thromboxane A2
  • Complement
A
  • Prostaglandin: vasodilation/constriction, platelet disaggregation
  • Bradykinin: inc capillary permeability
  • Thromboxane A2: Vasoconstriction
  • Complement: attraction of leukocyte and leukotriene release
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15
Q

Renin release is (Increased/Decreased) in cirrhotic pts secondary to _______ factors that are released

A

Increased

  • Cirrhosis: hyperdynamic circulatory system (high Cardiac output, reduced systemic vascular resistance, reduced arterial pressure), secondary to vasodilating factors (NO, VIP)
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16
Q

In hepatopulmonary syndrome, _______is d/t an increased shunting of blood through the lungs, causing dyspnea.

A

platypnea (dyspnea while sitting)

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17
Q

the ____ wave on a central venous pressure (CVP) tracing is a result of increased venous return and systolic filling of the RA

A

v wave

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18
Q

Central venous pressure (CVP) waveforms are classically defined by 5 phasic events:

A

a, c , v waves (peaks)

x, y (descents)

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19
Q

Central Venous Pressure (CVP) is used to assess _____ and evaluate ____

A

R heart function

blood volume

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20
Q

The most prominant wave of the CVP tracing occurs during ___ which is noted by the ___ wave

A

atrial contraction, “atrial kick”

a wave

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21
Q

Central venous pressure (CVP) waveform changes in:

- a fib

A

loss of a wave

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22
Q

Central venous pressure (CVP) waveform changes in:

- AV dissociation

A

cannon a wave

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23
Q

Central venous pressure (CVP) waveform changes in:

- Tricuspid regurg

A

Tall C & V waves

Loss of x descent

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24
Q

Central venous pressure (CVP) waveform changes in:

- Tricuspid stenosis

A

tall a & v waves

minimal y descent

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25
Q

Central venous pressure (CVP) waveform changes in:

- RV ischemia

A

Tall a & v waves
Steep x & y descent
M or W configuration

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26
Q

Central venous pressure (CVP) waveform changes in:

- Pericardial constriction

A

Tall a & v waves
Steep x & y descent
M or W config

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27
Q

Central venous pressure (CVP) waveform changes in:

- Cardiac tamponade

A

dominant x descent

minimal y descent

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28
Q

Normal Central venous pressure (CVP) tracing:
____: atrial contraction
____: TV buldging into RA during RV isovol contraction
____: TV descends into RV with vent. ejection and atrial relaxation
____: venous return to and systolic filling of the RA
____: atrial emptying into RV through open TV

A

a wave : atrial contraction

c wave: TV buldging into RA during RV isovol contraction

x descent: TV descends into RV with vent. ejection and atrial relaxation

v wave: venous return to and systolic filling of the RA

y descent: atrial emptying into RV through open TV

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29
Q

First line treatment in cyanide toxicity

A

hydroxocobalamin

Sodium thiosulfate (older and slower)

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30
Q

Pts with cyanide toxicity may show normal oxygenation with metabolic ______.

A

acidosis

but could be masked by respiratory compensation

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31
Q

Hydrocortisone (promotes/inhibits) nitric oxide synthesis

A

inhibits

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32
Q

Of the 4 etiologies of hypoxemia, _____ is the only one which shows a normal a-a gradient

A

hypoventilation

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33
Q

______ is the most common cause of hypoxemia and will response to increased FiO2

A

V/P mismatch

- atelectasis, bronchospasm, COPD, airway obstruction, PNA

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34
Q

Strong Ion Difference (SID) in pts can be reduced by _______.

A

infusing lg volumes of fluid that has a SID of zero (ie: NS) to create dilutional acidosis

ie: cl-, lactate, HCO3-, PO34-, Albumin

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35
Q

Strong ion difference (SID) is normally ___ mEq/L

A

40

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36
Q

Tx for infant < 1 yr and adult botulism

A

Infant < 1 yr: Hu Ig

Age > 1 yr: equine derived antitoxin

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37
Q

onset of paralysis for botulism toxin is ____, and peaks at ____, and stabilizes at _____

A

6 - 72 hrs

2 weeks

10 weeks

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38
Q

(Hyper/Hypo)phosphatemia causes muscle weakness d/t lack of energy source. Cause difficulty weaning off mechanical ventilation.

A

Hypophosphatemia

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39
Q

Drugs common with drug fever

A
  1. amphotericin
  2. cephalosporins
  3. PCN
  4. phenytoin
  5. procainamide
  6. quinidine
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40
Q

ARDS net uses TV of ___ mL/kg of PBW and plateau pressures of ___ cm H2O

A

6 mL/kg

< 30 cm H2O

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41
Q

Use of vasopressin in pts with CAD can ppt _________ d/t ______

A

MI

- Vasoconstriction of coronary arteries

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42
Q

Vasopressin aka _____, promotes reabsorption of water in kidney tubules by increasing cell membrane permeability

A

ADH

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43
Q

Is it safe to give vaso in pts with renal dysfunction and liver failure secondary to hepatitis?

A

Yes

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44
Q

Calcium gluconate is used to treat (Hyper/Hypo) magnesemia.

Ca can raise BP quickly, easily titratable, and is readily available

A

Hypermag

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45
Q

PLasma OSM equation

A

2 * Na + Glucose/18 + BUN/2.8

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46
Q

Significant increase in angiotensin II in approximately ___ (time) after a blood pressure decrease is sensed by juxtaglomerular apparatus

A

20 minutes

*after anesthetic induction in nl pts, transient hypotension is offset by RAAS in ~20 min

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47
Q

Renin, a protease synthesized in the JGA, cleaves _____ in the blood to yield _____

A

Angiotensinogen

Angiotensin I

48
Q

Angiotensin I is cleaved to Angiotensin II by ____

A

ACE

49
Q

Angiotensin II (Directly/Indirectly) increases BP by stimulating the secretion of ______ from the zona glomerula of the adrenal glands

A

Indirectly

Aldosterone

50
Q

Anuria is u/o < __mL per day

A

50 mL

51
Q

Pre-Renal
FeNa = ___
Urine Na = __

A

< 1

< 20

52
Q

Renal
FeNa = ___
Urine Na = __

A

> 2

> 40

53
Q

__% of rocuronium is renally excreted.

A

30%

54
Q

______ and _____ have minimal renal excretion and predictable durations of action in pts with renal failure

A

Succinylcholine and cistatracurium

55
Q

(Hyper/Hypo)calcemia is expected in pts with ESRD.

A

Hypocalcemia

  • Kidney loses ability to reabsorb Ca
  • Kidney converts less 25-hydroxycholecalciferol -> 1,25-hydroxycholecalciferol -> less Ca absorption
56
Q

Which electrolytes are elevated in ESRD?

A

K+
Mg2+
PO4
Urea

57
Q

K+ < __ mEq/L warrants delay of non-emergent surgery

A

2.5

58
Q

KDIGO guidelines define AKI as _____ (3 things)

A

increase in Cr by 0.3mg/dL over 48 h.

or

Increase in serum Cr to < 1.5 baseline in 7d

or

Urine volume < 0.5 ml/kg/hr for >6h

59
Q

Sevoflurane produces ______ and ____, which has potential nephrotoxicity (controversial as it is not linked in humans

A

Compound A and Fl-

*FDA: use at least 2L/min fresh gas flow to reduce compound A and increase washout

60
Q

Nephrotoxic volatile agents

A

methoxyflurane and enflurane

61
Q

Quickest way to improve oxygenation during 1 lung ventilation?

A

resume two lung ventilation

62
Q

Hypoxemia primarily occurs during one lung ventilation d/t the perfusion of the _____ lung, even in the setting of appropriate hypoxic pulmonary vasoconstriction

A

non-dependent (non-ventilated) lung

63
Q

What is the quickest way to improve oxygenation during 1 lung ventilation IF you cannot resume two lung ventilation?

A

Ligate or clamp the pulmonary artery supplying the non-dependent lung

64
Q

CPAP can improve oxygenation with the exception of: (2)

A
  1. Occlusion of main bronchus

2. Bronchopleural fistula

65
Q

Flow volume loop of COPD

  • The _____ curve looks normal.
  • The _____ phase quickly peaks then falls to a lower than nl plateau pressure
A

Inspiratory curve

Expiratory

66
Q

Severe hypoxia under one lung ventilation, after confirming DLT position, assuring 100% O2, and maintaining nl CO, is treated by applying ____ to the dependent lung, and ____ to the non-dependent lung.

A

PEEP

CPAP

*for pts w/o COPD

67
Q

Head down (Trendelenburg) is associated with an (Increase/Decrease) in Cardiac index and (Increase/Decrease) in FRC

A

Increase

*increase venous return -> increase in stroke volume -> increase in cardiac index/output

Decrease
- d/t reduction in ERV

68
Q

Head down (Trendelenburg) is associated with an (Increase/Decrease) in Cardiac index

A

Increase

*increase venous return -> increase in stroke volume -> increase in cardiac index/output

69
Q

After smoking cessation, carbon monoxide levels normalize after ___, mucociliary function begin to normalize after ___ , and risk of post op complications are maxed at ____.

A

24 hours

3 weeks

8 weeks

70
Q

The greatest benefit of smoking cessation is seen after ___ weeks

A

8 weeks

71
Q

Prone pulmonary changes after heart and abdomen is able to hang freely and relieve the diaphragm of upward pressure and positive pressure is more evenly distributed.

A
  1. Increase ERV and FRC
  2. Improved pulmonary compliance!
  3. Decrease atelectasis
  4. Improved V/Q matching
  5. Decreased lung stress and strain
72
Q

Maximum voluntary ventilation (MVV) of > ___ % of the predicted value is shown to be associated w/ good postoperative prognosis after pneumonectomy

A

> 50%

73
Q

Preoperative ABG criteria that predict increased perioperative morbidity and mortality in pneumonectomy include:

  1. PaO2
  2. PaCO2
A

PaO2 < 50 mmHg on RA

PaCO2 > 45

74
Q

Preoperative spirometry criteria that predict increased perioperative morbidity and mortality in pneumonectomy include:

  1. FVC ___
  2. FEV1 ___
  3. FEV1/FVC ___
  4. MVV ___
  5. DLCO ___
A

FVC < 50%

FEV1 < 2L

FEV1/FVC < 50%

MVV < 50%

DLCO < 50

75
Q

Pneumonectomy preop critheria:

- Phase 1 testing what happens if pts fail vs pass?

A

Phase 1 fail: start second phase of testing (split lung function)

Phase 1 pass: proceed to lung resection

76
Q

Shunt is also known as ________. Portion of the lungs that are ____ but not _____

A

venous admixture

Perfused, but not ventilated

77
Q

______ can be defined as a passage of blood from the systemic venous system to the arterial system without being exposed to alveolar gas

A

Shunt

78
Q

In the perioperative period, the most common cause of shunt is ______, and is a very important cause of hypoxemia

A

atelectasis

79
Q

Increasing inspired concentration of oxygen increases shunt fraction secondary to ___________

A

the attenuation of hypoxic pulmonary vasoconstriction and microatelectasis

80
Q

Leftward shift of oxyhemoglobin dissociation curve is a feature of
(Alpha-stat ABG / pH-Stat), by allowing pH to rise naturally during cooler body temperatures, and is not corrected for pt body temperature

A

alpha-stat ABG

81
Q

During _____ ABG management, CO2 is added to overcome hypothermia induced alkalosis and maintain pH at 7.4

A

pH-stat

82
Q

_______ is a well documented effect that can be observed following the cessation of an inhaled anesthetic involving the use of high [ ]s of nitrous oxide. The flooding of NO results in the displacement of oxygen and carbon dioxide in the alveoli, leading to temporary hypoxia.

A

Diffusion Hypoxia (“Fink Effect”)

83
Q

Nitrous Oxide blood:gas coefficient

A

0.47

84
Q

Ketamine MOA

A

NMDA antagonist

85
Q

~80% o f resistance to gas flow during ventilation occurs in the _________

A

large airways including upper bronchi

  • Lower cross sectional area, greater resistance to flow
  • more turbulent flow
86
Q

As temperature decreases, PaCO2 will (Increase/Decrease) since partial pressure is proportional to temperature and pH will (Increase/Decrease)

A

decrease

alkalotic

87
Q

The gradient btwn PaCO2 and ETCO2 normally reflects ______

A

dead space

88
Q

normall __CO2 is slightly higher than __CO2 and is a result of deadspace ventilation

A

PaCO2 > ETCO2

89
Q

most common complication of celiac plexus blockade (done from the back or retrocrural approach under flouroscopy)

A

orthostatic hypotension

- d/t vasocilation of splanchnic vessels, increasing venous capacitance

90
Q

_____ is a sympathetic plexus that provides sympathetic output and receives sensory innervation from much of the abdominal viscera

A

celiac plexus block

91
Q

Orthostatic hypotension occurs when systolic BP drops by ___ mmHg or diastolic BP drops by __ mmHg

A

20 mmHg

10 mmHg

92
Q

second most common complication of celiac plexus blockade (done from the back or retrocrural approach under flouroscopy)

A

Diarrhea

  • d/t autonomic imbalance favoring parasympathetic over sympathetic
  • (greater sympathetic blockade)
93
Q

Stellate ganglion blocks in the neck are performed to diagnose _______

A

sympathetically mediated pain of the upper extremity

94
Q

______ is a sympathetic ganglion comprised of the inferior cervical and first thoracic sympathetic ganglia and lies in close proximity to the carotid artery, internal jugular vein, lung, and brachial plexus

A

stellate ganglion

95
Q

Horner syndrome a complication of (stellate/ celiac) ganglion blocks

A

stellate

*ptosis, miosis, anhydrosis

96
Q

_____ is the enzyme that produces prostaglandins which have general ‘housekeeping” functions such as gastric protection and hemostasis

A

Cox-1

97
Q

__ is the enzyme that produces prostaglandins that mediate pain, inflammation, fever, and carcinogenesis

A

Cox-2

98
Q

Which drugs have ceiling effect, and are ineffective beyond a certain dose

  • NSAIDs
  • Mixed agonist-antagonist opioids
  • Pure mu-agonist opioids
A

NSAIDS and mixed agonist-antagonist

99
Q

_______ is considered first line tx and standard of care in pts w/ moderate-severe cancer pain

A

morphine

100
Q

__________ is the major metabolite of morphine, but does not bind opioid rcptrs and possess little or no analgesic activity

A

Morphine - 3 - glucuronide

101
Q

_______is the major metabolite of morphine, and contributes substantially to its analgesic effects

A

morphine - 6 - glucuronide

102
Q

Phantom limb pain is a type of which pain?

A

Neuropathic pain

103
Q

Most common indication for epidural steroid injections

A

radicular back pain along

a nerve distribution caused by herniated disc

104
Q

_______ is herpes zoster pain that persists beyond vesicular rash and can last 4-6 weeks. Sympathetic blocks are effective for acute herpes zoster, but this.

A

postherpetic neuralgia

105
Q

________ pain is decreased with standing and increased with bending/sitting

A

discogenic

106
Q

peripheral neuropathy in diabetes mellitus is related to __________

A

microangiopathy ( ischemia in axonal nerve tissue)

107
Q

Pain is conducted along three neuronal pathways from peripheral transduction to the __________ cortex, through first, second, and third order neurons.

A

cerebral somatosensory

108
Q

First order neurons secrete chemical mediators of pain and signals begin with transduction and ends with synapse traveling to the _____.

A

dorsal horn

109
Q

Second-order neuron begins at the ______ and ends at the ______

A

dorsal horn,

thalamus

110
Q

Third-order neuron begins at the ______ and follows the axonal pathway to the ______

A

Thalamus

postcentral gyrus

111
Q

Signals carried by the spinothalamic tract

A

crude touch, pain, temp

112
Q

Metabolism by most opioids are by the hepatic CYP ___ enzyme

A

CYP3A4

113
Q

Remifentanil is metabolized by ________

A

plasma esterases

114
Q

Negative immune effects of opioids include:
Inhibition of ___ transcription
and ____

A

IL-2 transcription

cancer recurrence

115
Q

Oxycodone, tramadol, and hydrocodone is metabolized by CYP ___

A

CYP 450 2D6

Anesthesia 101 (38 decks)

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