ITE Questions Flashcards
What are the 7 conditions approved for hyperbaric oxygen therapy treatment?
- Gas-bubble disease (air embolism/decompression sickness)
- Carbon monoxide poisoning
- Infections (soft tissue necrotizing infections)
- Acute/Chronic tissue ischemia
- Acute hypoxia (blood-loss anemia when transfusion unable to be given)
- Acute thermal burn injury
- Idiopathic sudden sensorineural hearing loss
What are transient neurological symptoms (TNS)? What are the risk factors for the development of TNS (4)?
- Characterized by pain in the butt or legs following spinal anesthesia (usually sef-limiting to 72 hours)
1. Lithotomy position
2. Lidocaine use
3. Addition of phenylephrine to 0.5% tetracaine
4. Pts. who undergo outpatient procedures
How much does oxygen consumption increase during the 1st and 2nd stage of labor?
- Oxygen demand increases by 40% in the 1st stage, and 75% in the 2nd stage
- These demands can be reduced w/ analgesics, especially neuraxial anesthesia
Neurological monitoring (BIS or Entropy) does not correspond to which 3 anesthetic agents?
- Nitrous oxide
- Ketamine (N2O and ketamine can induce anesthesia w/ a high BIS/Entropy value)
- Dexmedetomidine (can produce a low BIS/Entropy value w/o inducing general anesthesia)
What is the treatment for organophosphate poisoning? What can be taken for prophylaxis?
- Atropine (to reduce muscarinic-mediated side effects), pralidoxime chloride (removes organophosphate compound from acetylcholinesterase), decontamination, and supportive therapy if necessary
- Pyridostigmine is effective for prophylaxis, if taken greater than 30 minutes before exposure
What 3 diagnostic tests can help differentiate ATN from acute kidney injury?
- Urinalysis
- Fractional excretion of sodium (FENa)
- Response to fluid challenge
In what age group is emergence delirium most common? What medications can decrease incidence of ED?
- It is most common in children between the ages of 2-5 who undergo a painful procedure under general inhalational anesthesia
- Prophylactic administration of clonidine, dexmedetomidine, fentanyl, ketamine, nalbuphine, or propofol can decrease incidence
What are the 3 diseases that are closely associated w/ malignant hyperthermia? What is the earliest sign of MH? Treatment?
- Central Core Disease
- Multi-Minicore Disease
- King-Denborough Syndrome
-The earliest sign of MH is a rapid rise of end-tidal CO2. Treatment is 2.5 mg/kg of dantrolene
What are the 2 most common risks of using TPN?
-Infection is the most common risk, and thrombophlebitis is the next most common risk, esp. w/ peripherally-delivered TPN
What are values for extracellular/intracellular body weight percentages in neonates? When to the compartments reach adult levels?
- Neonates have an extracellular compartment of 40% and intracellular compartment of 20% of their body weight. The compartments reach adult levels at 1 year of age (Adult levels are reversed: Extra: 20%, Intra: 40%)
- Preterm infants have a higher total body water compared to term infants
What factors decrease FRC? When does the greatest decrease occur?
- It is reduced by obesity, in females (10% less than males), and when moving from upright to supine/prone/Trendelenburg position
- FRC is highest when in an upright position. The greatest decrease occurs when going from 60 degrees to totally supine at 0 degrees. Beyond Trendelenburg of -30 degrees, the drop in FRC is considerable
What is the treatment of choice for pts. w/ Von Willebrands Disease?
- Desmopressin (DDAVP) is the treatment of choice for surgical bleeding in pts. w/ type-1 vWD
- Factor 8-vWF concentrate is useful in pts. w/ type 1 vWD who fail to respond to desmopressin, are undergoing major surgery, or in the setting of severe bleeding
In pts. w/ glaucoma, what medications should be avoided?
- Medications that cause mydriasis (anti-cholinergics and anti-histamines)
- Corticosteroids should be used cautiously in pts. w/ glaucoma
- Atropine and glycopyrrolate are considered safe to use in pts. w/ open or closed-angle glaucoma
What echocardiographic study provides a measure of right ventricular systolic function? What other studies (2) can provide this information?
- The tricuspid annular plane systolic excursion (TAPSE) can be used w/ TTE or TEE. A normal TAPSE is between 1.5-2 cm
- Cardiac MRI or MUGA scans can be used to calculate right ventricular EF also
What are considerations when using carboprost, methylergonovine, misoprostol, and oxytocin?
- Carboprost: venoconstriction, bronchospasm
- Methylergonovine: (alpha-receptor stimulation) alpha-mediated hypertension. Should not be used in pre-eclamptic pts.
- Misoprostol: uterine rupture is possible when used in pts. w/ history of c-section
- Oxytocin: vasodilation/hypotension. Can cause ADH-responses in large doses (water retention, hyponatremia)
What nerve root is affected by a far lateral/paracentral disc herniation?
- A far lateral herniation will affect the exiting nerve root at the level of the disc herniation
- A paracentral herniation will affect the nerve root at the level BELOW the disc herniation
Which cranial nerves have parasympathetic components? Where are they located?
- Cranial nerves 3, 7, 9, and 10 have parasympathetic components
- The component for cranial nerve 3 lies in the midbrain. The others lie within the medulla
What is the most common cause of pregnancy-related maternal mortality in the U.S.?
Maternal cardiovascular conditions (cardiomyopathy, congenital heart disease, CHF, hypertensive/ischemic/valvular disease)
What lung-related parameters are similar between neonates and adults?
- Tidal volume is comparable to an adult on a volume/kg basis
- Closing volume, respiratory rate, and minute ventilation are increased in neonates
What is 1st-line therapy for organophosphate poisoning/nerve agent exposure?
Atropine. It will antagonize muscarinic receptors causing a decrease in secretions and bronchospasm, and an increase in heart rate which will improve hemodynamics
What is the leading cause of perioperative mortality in morbidly obese pts.?
Deep vein thrombosis leading to PE
What kind of response can an IgA-deficient pt. have from a blood transfusion?
They are at risk for an anaphylactic response to IgA antibodies in donor blood. To avoid this reaction, these pts. should receive washed RBCs or blood from IgA-deficient donors
When should epinephrine be given in non-shockable rhythms during cardiac arrest?
As soon as possible
This does not apply for shockable rhythms
How does somatostatin affect other hormones?
It is an inhibitory hormone that suppresses the release of insulin, glucagon, growth hormone, and TSH