ITE QBANK Misc 3 Flashcards
Early adult onset ventilator assoc. PNA is typically d/t _____
MSSA
TCAs primary MOA is the inhibition of presynaptic neurotransmitter uptake _______ and _______
Norepi and serotonin
Treatment for TCA toxicity with ECG showing wide QRS interval
Sodium bicarb
Common metabolic changes seen with TPN (6)
- Hypercarbia
- Hyperglycemia
- Hyperinsulinemia
- Hypophosphatemia
- Hypokalemia
- Hypomagnesemia
*NOT sodium
Can hepatic steatosis be seen in TPN?
Yes - common
- liver will store excess sugar as fat in liver
Can hypocarbia or hypocapnia occur with TPN infusion?
No - HYPERcarbia or HYPERcapnia
- Pt will metabolize excess carbs into sugar and increase CO2 production.
Can hypernatremia occur with TPN?
Unlikely
- more common in pts not receiving enough free water (calculate deficit and give as free water bolus)
Is low dose corticosteroids good for tx of septic shock?
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
____________ is defined as intrapulmonary vascular dilatations and increased A-a oxygen gradient, in the setting of end-stage liver disease
Hepatopulmonary syndrome
*Pts with hepatic failure have excessive circulating levels of NO –> excessive pulmonary vasodilators.
In hepatopulmonary syndrome, hypoxia is _____ when the pt lies flat, and ______ when the pt stands
Improved (platypnea)
worsened (orthodeoxia)
*worsened by increasing VP mismatch
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.
> 35 mmHg
> 50 mmHg
Septic shock is a dyregulated response to infection, causing a metabolic _______ with compensatory ______
acidosis
respiratory alkalosis
Phosgene (chemical warfare agent) exposure can cause severe ________, which can cause significant morbidity and mortality
pulmonary edema
*targets type I and II pneumocytes
Inflammatory mediators cause:
- Prostaglandin:
- Bradykinin:
- Thromboxane A2
- Complement
- Prostaglandin: vasodilation/constriction, platelet disaggregation
- Bradykinin: inc capillary permeability
- Thromboxane A2: Vasoconstriction
- Complement: attraction of leukocyte and leukotriene release
Renin release is (Increased/Decreased) in cirrhotic pts secondary to _______ factors that are released
Increased
- Cirrhosis: hyperdynamic circulatory system (high Cardiac output, reduced systemic vascular resistance, reduced arterial pressure), secondary to vasodilating factors (NO, VIP)
In hepatopulmonary syndrome, _______is d/t an increased shunting of blood through the lungs, causing dyspnea.
platypnea (dyspnea while sitting)
the ____ wave on a central venous pressure (CVP) tracing is a result of increased venous return and systolic filling of the RA
v wave
Central venous pressure (CVP) waveforms are classically defined by 5 phasic events:
a, c , v waves (peaks)
x, y (descents)
Central Venous Pressure (CVP) is used to assess _____ and evaluate ____
R heart function
blood volume
The most prominant wave of the CVP tracing occurs during ___ which is noted by the ___ wave
atrial contraction, “atrial kick”
a wave
Central venous pressure (CVP) waveform changes in:
- a fib
loss of a wave
Central venous pressure (CVP) waveform changes in:
- AV dissociation
cannon a wave
Central venous pressure (CVP) waveform changes in:
- Tricuspid regurg
Tall C & V waves
Loss of x descent
Central venous pressure (CVP) waveform changes in:
- Tricuspid stenosis
tall a & v waves
minimal y descent