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In Training Exam TL > ITE TL block 2 > Flashcards

ITE TL block 2 Flashcards

1
Q

Best way to assess hepatic synthetic function

A

factor VII (1/2 life of 4 hours) so 1st to change if there is an issue w/ hepatic fxn
-fibrinogen changes 2nd (1/2 life 4 days), albumin 1/2 life is 20 days

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2
Q

measure hepatic excretory function

A

bilirubin

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3
Q

What is Gilbert Syndrome?

A

MC inherited hyperbili (indirect hyperbili) usually elevated but < 3 after trigger (trauma, surgery, illness, fasting, alcohol)
-due to dec in UDP-glucuronosyltransferase activity causing dec in conjugation of bili

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4
Q

How to diagnose Gilbert Syndrome and symptoms

A

PCR gene mutation
symp: fatigue, loss of appetite w/ transient, mild, jaundice
labs: mild indirect hyperbili (high but < 3), no evidence of hemolysis, and otherwise normal liver fxn

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5
Q

sudden, painless bright red vaginal bleeding after 20 weeks gestation

A

placenta previa
-abnormal placenta implantation partially or completely blocking internal cervical os

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6
Q

RF for placenta previa

A

previous c/s
prev pregnancy termination
prev uterine surgery
smoking
adv maternal age
multiple gestation
multiparity
cocaine abuse
-higher risk w/ higher # of c/s and parity

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7
Q

sudden painful vaginal bleeding

A

placental abruption
-premature separation of placenta from uterus
-fetal distres

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8
Q

severe sudden abd pain during labor, pause in contractions, vaginal bleeding, hemodynamic instability

A

uterine rupture

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9
Q

sudden, painless vaginal bleeding after rupture of mebranes

A

vasa previa
-fetal blood vessels overlying internal cerival os not protected by placenta or umbilical cord
-can cause fetal exsanguination

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10
Q

When to get an EKG for a preop workup

A

hx of cardiovascular dx, resp dx and type of surgery
-routine testing not indicated

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11
Q

When to get electrolytes/chemistry panels before surgery

A

endocrine, renal, liver d/o, certain medication use, potential for periop therapies that would alter a chemistry

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12
Q

hg/hct preop testing when

A

hx of known liver dx, history of anemia, hematologic d/c, type and invasiveness of procedure

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13
Q

Why dec DLCO on spirometry

A

Increased thickness of alveolar membrane
Dec alveolar membrane surface area
small pressure gradient b/w alveolar gas partial press and capillary gas tension

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14
Q

Why dec DLCO in pulm HTN

A

remodeling and loss of pulm vasculature -> thickened alveolar membrane and dec blood volume to participate in gas exchange

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15
Q

solubility of anesthetics w/ tempm, and hydrophobilicity

A

-solubility of inh anesthetics inc as temp decreases, and decreases as temp inc (as temp inc, exists as a gas, not soluble)
-hydrophobic nature of inh anesthetics -> higher solubility in tissues w/ higher lipid content than blood

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16
Q

Maintanence of Certification 2.0 requirements

A

Must occur in every 10 year period:
-must hold an active, unrestricted medical license in 1 jurisdiction in US or Canada
-Complete 250 Category 1 CME credits (125 must be done by year 5), 20 must be ABA-approved patient safety
-30 MOCA MC questions every calendar quarter for 120 questions per year
-points awarded for activities include clinical practice assessments and systems-based practices (QI): 25 points in 1st 5 years and 25 more in second 5 years 50 total

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17
Q

FEV1/FVC ratios for normal, obstructive, and restrictive dx

A

Normal ratio: 85%
Restrictive: 90% (normal ratio, but dec FEV1 and FVC)
Obstructive: 53%

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18
Q

Obstructive lung dx PFTs

A

-FEV1/FVC ratio of < 70% of predicted
-FEV1 < 50% predicted
-only slight dec/maintain FVC

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19
Q

FEV1, FVC, FEV1:FVC ratio for norm, obst, rest

A
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20
Q

COPD severity scale

A

Stage 1 mild: FEV1 80% or greater of predicted
Stage 2 moderate: FEV1 50-79% predicted
Stage 3 severe: FEV1 30-49% predicted
Stage 4 very severe: FEV1 less than 30% of predicted

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21
Q

Difference b/w gastric volumes and pH when clear liquids NPO >4 hrs or 2-4 hours

A

equivocal volumes and pH

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22
Q

NPO guidelines clear liquids, breast milk, reg milk, fatty foods

A

clear liquids: 2 hours
breast milk: 4 hours
milk formula or light meal: 6 hours
fatty foods: 8 hours

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23
Q

Why dec FRC in pregnancy?

A

-large uterus pushes diaphgram cephalad -> dec FRC
-dec FRC b/c dec ERV and RV

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24
Q

How long does it take for ventilation to return to normal

A

1-3 weeks postpartum

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25
Q

Airway in preegnancy

A

friable due to capillary engorgement
-edema of oropharynx, larynx and trachea begin 1st trimester
-b/c edema: mask, DL, intubation harder
-edema on extubation can compromise airway
-use 6-7 ETT

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26
Q

treatment of opioid-induced pruritis w/o ruining pain from opioids

A

Nalbuphine

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27
Q

Tx for opioid induced constipation (opioid agonist)

A

Methylnaltrexone
-peripheral mu-opioid antagonist

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28
Q

Nalbuphine MOA

A

mixed opioid agonist/anatagonist
-agonist of kappa opioid, antagonist of mu

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29
Q

Why urinary retention w/ spinal

A

Blockade of S2-4: dec strength of detrusor muscle -> weak/inh urinary function
-reduces sensation of urinary urge

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30
Q

What is hyperkalemic periodic paralysis? inheritance pattern?

A

Auto Dom
-weawkness accompanied by hyperkalemia w/ K up to 6

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31
Q

How to prevent hyperK periodic paralysis attack

A

avoid K-containing solutions
-avoid hypothermia (further impairs ion channel)
-give glucose or insulin
-albuterol
-mild exercise
-HCTZ (K wasting diuretic used as ppx)

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32
Q

Succ and GI effects

A

-inc intragastric pressure < inc in lower esophageal sphincter tone
-concern due to LES incompetence -> give NDNM pre-succ to avoid inc in intragastric pressure

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33
Q

Milrinone mechanism of action

A

selective PDE III inhibitor -> dec hydrolysis of cAMP -> inc cAMP causes inc contractility, HR, and conduction velocity

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34
Q

Best medications to inc HR in a denervated heart

A

isoproterneol and epi

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35
Q

Levosimendan MOA

A

Ca sensitizing medication (inc cardiac sens to Ca) -> inc inotropy and CO
-SE: tachyarrhythmias and hypoTN

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36
Q

Dromotropy

A

conduction velocity

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37
Q

Milrinone effects

A

-inc contractility (inotropy), inc HR (chronotropy), inc conduction velocity (dromotropy) -> inc CO
-smooth m relaxation, dec EVEDP, improves pulm BF and LV filling (dec afterload)

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38
Q

Difference in flow volume loops w/ COPD, restrictive dx, fixed upper airway obstruction, intrathoracic/extrathoracic obstruction

A
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39
Q
A

COPD

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40
Q

mediastinal mass changes to flow volume loop

A

INTRAthoracic
-insp normal, exp problem
-b/c can pass w/ negative intrathoracic pressure, blocked w/ positive intrathoracic pressure during exp

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41
Q

proximal tracheal tumor flow volume loop

A

-flat insp curve, normal exp curve
-b/c neg intrathoracic pressure pulls in causing it to obstruct more, postive intrathrocic pressure causes it to move

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42
Q

fixed upper airway obstruction curves

A

impairs both insp and exp

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43
Q

What nerve likely to get injured during PDA repair

A

recurrent laryngeal n (branch of vagus: CN X)

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44
Q

Why does PDA close when infant born

A

inc in arterial O2 and decreased PG ->constriction of ductus

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45
Q

tx of PDA

A

NSAIDS (indomethacin, ibuprofen) or surgery

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46
Q

Best way to dec cardiac demand and inc O2 supply

A

Dec HR
-less m use when beating slower
-dec O2 demand w/ dec HR
-inc time in diastole, allowing longer for O2 to get to heart

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47
Q

O2 content of blood equation

A

CAO2 = (Hgb x 1.34 x SaO2) + (.003 x PaO2)

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48
Q

Cardiac Perfusion pressure

A

CPP = Aortic DBP - LVEDP

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49
Q

Heart wall tension equation

A

Tension = (LVEDP x radius) / (2 x LV wall thickness)

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50
Q

When is RV perfused?

A

Throughout cardiac cycle
-greatest perfusion during peak/late systole and early diastole

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51
Q

Botulinum toxin MOA

A

Blocks release of ACh at muscarinic and nicotinic receptors
-inh fusion of ACh vesicles to nerve terminal -> can’t release into synapse (cleaves SNARE proteins)

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52
Q

Sarin MOA

A

inhibits AChE -> continual transmission of n impulses and can’t control resp muscles

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53
Q

Tetrodotoxin MOA

A

inhibits fast Na currents in myocytes and prevents contraction of resp muscles

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54
Q

MCC of fire ignition in OR

A

electrocautery unit

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55
Q

What do you need for fire in OR?

A

-ignition source (laser, cautery)
-fuel (surgical prep, drapes, ETT, O2 tubing)
-oxidizer (O2, nitrous oxide)

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56
Q

RF for OR fires

A

-MAC w/ open O2 delivery system
-outpt surgery
-head/neck/upper chest surgeries
-older pt age

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57
Q

MOA enoxaparin

A

binds and enhances antithrombin 3 (like heparin), difference is it preferentially inhibits factor Xa

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58
Q

If long heparin infusion and bolusing pt’s heparin and it’s not working tx?

A

ATIII (prob def) or if they don’t have FFP

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59
Q

RF for PDPH

A

-age, more common < 30, uncommon > 60
-women 2x more likely
-skinny (less likely in morbidly obese)
-pregnancy
-previous hx
-inc risk w/ inc needle gauge

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60
Q

Chronic opioid therapy and hormones

A

-unbalanced hypothalamic-adrenal axis and hypothalamic-gonadal axis
-inc prolactin levels, dec testosterone, estrogen, cortisol, LH and FSH
-male/female infertility, red libido, galactorrhea, menstrual changes
-Addisonian sym from dec cortisol: orthostatic hypoTN, m weakness, hyperpigmentation
-immunosuppression

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61
Q

MC side effects of ondansetron

A

QTc prolongation > HA
-prolongation is 20-30 msec or less

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62
Q

Rocuronium excretion

A

-25-30% renally excreted, majority cleared by hepatic uptake and hepatobiliary excretion
***prolonged paralysis in pts with cirrhosis and liver failure

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63
Q

closing capacity

A

volume remaining in the lungs during expiration when alveoli BEGIN to close
-CC = closing volume + RV

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64
Q

Why inc small airway collapse in elderly

A

-inc closing capacity
-small airways not stiff enough to remain open and depend on elastance of lung parenchyma to stay open -> dec elasticity w/ age -> CC surpasses FRV

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65
Q

Resp change sin elderly

A

-inc chest wall stiffness, loss of m mass, flattening of diagram, and inc compliance of lung
-inc CC, inc RV, inc FRC
-dec TLC, dec IC

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66
Q

RF of phantom limb pain

A

preamputation pain

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67
Q

APGAR score

A

max: 10
2 pst for each category
Appearance, Pulse, Grimace, Activity, Respiration

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68
Q

When using oral dantrolene what lab should be monitored?

A

LFTs!!
CI: cirrhosis, hepatitis B or C, nonalcoholic stateohepatitis
-d/c if LFTs elevated or s/s of hepatic issues ie jaundice or RUQ pain

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69
Q

What local anesthestics cause methemoglobinemia

A

Prilocaine or Benzocaine

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70
Q

Tx for Met-Hg if G6PD def

A

Ascorbic Acid (Vit C)

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71
Q

Acquired cases of MetHg

A

-prilocaine, benzocaine
-metoclopramide
-nitrites (nitric ocide and NG)
-aniline dyes
-benzene
-chloroquine
-dapsone (abx for leprosy, dermatitis herpetiformis)
-sulfonamides

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72
Q

Methylene Blue MOA and risks

A

monoamine oxidase inhibitor
-can cause serotonin crisis w/ SSRI

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73
Q

PFTs in restrictive lung dx

A

Dec FEV1, Dec FVC, FEV1/FVC ratio > 0.7

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74
Q

What cysto fluid during TURP causes hypoNa and inc ammonia

A

Glycine solution
-may cause neuro complications incl encephalopathy and coma
-can also have vision changes due to brainstem or CN inh w/ glycine (structurally similar to GABA)

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75
Q

what cysto fluid TURP causes hyperglycemia and osmotic diuresis

A

sorbitol solutions

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76
Q

cyto fluid TURP causes hypoNa, hemolysis, hemoglobinuria

A

Distilled water

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77
Q

Best way to monitor recurrent laryngeal n fxn during thyroid surgery

A

intermittent/continuous EMG

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78
Q

afferent/efferent for corneal reflex

A

afferent: trigeminal nerve (ophthalmic branch)
efferent: facial (temporal and zygomatic)
goes Away Afferent to cause an Effect Efferent

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79
Q

afferent/efferent pupillary light reflex

A

Afferent: optic n
Efferent: Oculomotor n

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80
Q

three surgeons want to compare intraop times, what statistical analysis?

A

ANOVA
(more than 2 groups)

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81
Q

How does PE occur?

A

Triad: endothelial injury, venous stasis, hypercoagulability
-get thrombus -> embolizes travels to R heart and into pulm circ

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82
Q

orthopedic long bone fracture, petechial rash, resp compromise

A

fat embolism syndrome
-showering of fat/bone marrow into systemic circulation -> lodges in capillaries of organs (mostly skin and lungs)

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83
Q

what happens in amniotic fluid embolism?

A

amniotic fluid in circulation -> massive activation of systemic inflammation
-b/c amniotic fluid has so many vasoactive and procoag -> when in systemic circ massive inflammation and DIC
-endothelin causes bronchoconstriction and pulm/coronary vasoconstriction

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84
Q

fenestrated trach tube

A

openings in outer cannula -> allows air tot pass through pts oral/nasal pharynx to speak and cough
-inc risk risk of oral/gastric aspiration
-cant be used for PPV

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85
Q

what is a laryngectomy stoma tube

A

they’ve had part of their trachea removed, so there is no connection b/w trach and mouth/nose so can only be intubated through stoma

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86
Q

Myotonic dystrophy

A

Muscles cant relax: Ca doesn’t return to SR so sustained contraction
-symp: m degen, cataracts, DM, thyroid prob, adrenal insuff, gonadal atropy, heart abnorm (conduction dysfxn, cardiomyopathy, MVP)
-resp m weakness : restrictive dx, ineffective coughing, hypoxemia and hypercapnia
-GI m weakness: delayed emptying, hypomotility, pharyngeal m weakness -> inc aspiration risk

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87
Q

Triggers for myotonic episodes

A

shivering 2/2 hypothermia
neostigmine
succ
directly surgical stimulation of m (esp by cautery)

88
Q

Treatment of myotonia or myotonic crises

A

phenytoin
quinine
procainamide
-direct infiltration of affected m w/ local anesthetics
-high conc of volatile anesthetics
**can also be used as ppx
-dec Na influx into myoctyes, and delaying return of membrane excitability

89
Q

post SAH, hypoNa, euvolemic, high urine Na and high urine osmolarity, dx?

A

SIADH
-tx: free water restriction

90
Q

post SAH, hypoNa, hypovolemic, high urine Na and high urine osmolarity, dx?

A

cerebral salt wasting
-tx: free water and Na administration

91
Q

Difference b/w traditionally CAB and minimally invasive directly CAB

A

minimally invasive: small thoracotomy invasion may require single lung ventilation for visualization, can’t use paddles against heart, so external defib pads
-CBG avoided
-b/c no cardioplegia may require pharm bradycardia w/ transvenous pacing

92
Q

Advantages of minimally invasive CBG as opposed to traditional CBG

A

dec arrythmias
dec post-op wound infxn
dec coag d/o
dec blood transfusions
dec renal failure, stroke, hospital stay, cost

93
Q

MOA of uterotonicsc

A

carboprost: PG (bronchoconstriction)
misoprostol: PG
methylergometrine: ergot alkaloid (HTN)

94
Q

Why does Mg lower BP in preeclampsia

A

vasodilation w/ Mg -> dec in BP
-Mg competes w/ Calcium inside vascular smooth m -> prevents actin-myosin crosslinking -> dec SVR
-Mg also inc nitric oxide and PG -> vasodilation

95
Q

How does Mg help pain?

A

NMDA antag

96
Q

Tx for Mg toxicity

A

Give Ca (antag Mg) Cl central, gluconate PIV
-and supportive: support O2, ventilation and hemodynamics

97
Q

How does inhalation anesthesia potentiate NMB

A

-augmentation of antagonist affinity at the receptor site
-central effects on alpha motor neurons and interneuron synapses
-inhibition of postsynp nicotinic ACh receptors

98
Q

Which gas potentiates NMB the most?

A

Des > Sevo > Iso > halothane > nitrous oxide > TIVA w/ prop

99
Q

How is ACh broken down?

A

Cholinesterase into acetate and choline
-choline recycled by being transported back into neuron by Na+/choline transporters

100
Q

what makes the single largest difference on function after pancreatic transplant

A

donation after brain death allows for longer graft perfusion times compared to donation after cardiac death

101
Q

Pancreatic transplant considerations

A

-performed in conjuction w/ kidney transplant
-sensitive and require constant blood flow, graft thrombosis = re-exploration
-monitoring glucose essential after reperfusion -> releases insulin into circulation w/i minutes -> blood glucose every 30-60 minutes

102
Q

pain three neuronal pathways

A

first order neuron w/ transduction and ends w/ synapse at the dorsal horn
-second-order beings at dorsal horn ends at thalamus
-third-order involves thalamus and its axonal pathway to postcentral gyrus

**crude touch, pain, and temp along same pathway

103
Q

molecules that modulate pain in dorsal horn transmission

A

Adenosine
-substance P is also secreted

104
Q

Urine to plasma osmolar ratio indicated prerenal oliguira

A

> 1.5

105
Q

Myofascial pain syndrome

A

-trigger points in skeletal muscles 2/2 repetitive use or trauma
-localized pain, can get radiation non-dermatomal
-taut muscle, limited ROM
-can get autonomic dysfxn: piloerection, vasoconstrcition
-spontaneous activity on EMG can occur

106
Q

Tx of Myofascial pain syndrome

A

cold sprays (ethyl chloride) to relax m
-stretching exercises
-PT
-massage
-dry needling, injxn of local anesthetic
-trigger point injxn

107
Q

how to screen fo rcerebral vasospasm

A

transcranial doppler every 24-48 hours
-assesses flow velocity of the MCA and ICA
-vasospasm considered if FVMCA > 120 cm/s or FVMCA: FVICA > 3

108
Q

Compl of SAH and time frame

A

rebleeding: 24-48 hours
vasospasm: 3-15 days
-more bleeding, more risk of vasospasm

109
Q

tx of cerebral vasospasm

A

nimodipine

110
Q

Uterine blood flow

A

> 20 weeks: uterine blood vessels maximally dilated and entirely pressure-dependent
-autoregulation plays no role
-anesthesia can cause systemic vasodilation and myocardial depression -> dec uterine BF

111
Q

What nerve is blocked for cleft lip repair?

A

Infraorbital nerve
-maxillary branch of trigeminal (V2)
-sensory for lower eyelid, lateral nose, cheek, and upper lip

112
Q

Infraorbical nerve block

A

-intraoral: upper canine insert into buccal mucose move cephalad and lateral
-extraoral: preferred, palpate infraorbical foramen advance to bone, and inject

113
Q

When would you nerve block the ethmoidal foramen

A

nasociliary block for nasal septoplasty

114
Q

pregnancy and myotonic dystrophy

A

exacerbates it due to inc progesterone
-high incidence of OB complications (polyhydramnios, premature onset of labor, breech presentation, impaired cervical dilation, uterine atony, PPH_

115
Q

Myotonic dystrophy complications

A

progressive m weakness, cataracts
pulm restrictive lung dx due to contractures
-insulin resistasnce
issues w/ cardiac conduction
testicular atrophy

116
Q

Normal fetal a ABG

A

pH: 7.27
pCO2: 50
PO2 18
base excess - 2.7
-represents acid-base status of fetus
-lowo PO2 not a concern, pH, CO2 and base deficit more important

117
Q

diff in info b/w umbilical a and v

A

artery: acid-base of fetus
v: placental function

118
Q

Normal PCO2 and O2 in umbilical artery and vein

A
119
Q

why is a des vaporizer heated

A

-very high saturated vapor pressure (669 mmHg at 20C)
-to maintain constant vaporizer output, control temp -> vaporzier heated to 39C

120
Q

Peds laparoscopy compared to adults

A

-lower insufflation pressures needed (thinner peritoneum)
-lower risk of ileus w/ llaparoscopy compared to laparotomy
-inc uptake of CO2 due to thinner peritoneum and less act to act as a buffer -> inc MV!
-more cardiopulm disruptions -> inc pressure in abd causes IVC compression, movement of carina cephalad, dec UOP, inc ICP

121
Q

what test do you need before omphalocele repair done

A

TTE!
-20% have congenital haert disease

122
Q

Concerns for gastroschisis and omphalocele surgeries

A

-fluid balance! severe dehydration huge risk
-early parenteral feeding helps speed return of bowel fxn, dec infxn and improve wound healing
-liberal m relaxation
-when contents in abd, aortocaval compression => hypoTN
-inc intraabd pressures dec BF to liver and kidney -> dec metabolism of drugs
-postop ventation always required

123
Q

surgical blood loss in neonates replacement

A

1:1 colloid
1:1.5 isotonic crystalloidd

124
Q

Periop fluids in neonates

A

-higher rate of evaporative losses due to inc body surface area to mass ratio
-higher body water content
-higher metabolic rate (inc enzymatic activity) -> higher water requirement
-immature renal system -> poorly tolerated fluid shifts (takes 1 year to be almost equal to adult)

125
Q

Treatment of neonatal respiratory distress syndrome

A

Administration of CPAP (PEEP 3-8)
-endotracheal intubation despite CPAP, intratracheal admin of exogenous surfactant

126
Q

Anesthesia dolorosa

A

pain in an area that lacks sensation
-compl of neurolytic blocks for trigeminal neuralgia

127
Q

Treatment of anesthesia dolorosa

A

anticonvulsants, antidepressants, opiates, and psych support

128
Q

Allodynia

A

perception of ordinarily nonnoxious stimulus as being painful

129
Q

MC injured nerve in lithotomy position

A

common peroneal nerve
-more likely w/ low BMI and prolonged surgery

130
Q

Meralgia paresthetica

A

entrapment of the LFCN

131
Q

What is considered to be an anion gap metabolic acidosis

A

AG > 16
normal is 8-12

132
Q

Equation for anion gap

A

Na + K - (Cl + bicarb)

133
Q

Causes of non-gap acidosis

A

admin of NS
GI loss (diarrhea, fistula)
renal loss (renal tubular acidosis)
Acetazolamide

134
Q

Process for diagnosis of AG acidosis

A
  1. gap > 10?
  2. lactate -> if lactate above 2, it lactane from tissue hypoxia
  3. if lactate <2 look at ketones -> ddx DKA, starvation or alcohol ketoacidosis
  4. If ketones not present, renal failure? Look at osmolar gap
135
Q

Neuron action potential termination

A

-Na channels close (preventing further + input into cell)
-opening K channels to promote K efflux -> they overshoot to hyperpolarization (refractory period)

136
Q

MOA of local anesthetics

A

block n impulse transmission by reversibly binding to the intracellular potion of the VG Na channels and preventing Na influx

137
Q

Why does phenylephrine cause inc BP?

A

inc venous return (inc preload) and inv SVR
-arterial and venous constriction

138
Q

Pain ladder

A
  1. NSAIDS, acetaminophen
  2. mild opioids: codeine, tramadol
  3. strong opioids: morphine and hydromorphone
139
Q

What drug causes bronchospasm w/ asthma and nasal polyps

A

Ketorolac and Aspirin
-inc risk w/ histamine release (morphine, atracurium)

140
Q

In emergency type and screen completed and antibody screen negative, best way to proceed?

A

Transfuse w/ ABO and Rh compatible blood
-save O for emergencies w/o known blood type

141
Q

What is a type and screen

A

mix pt’s plasma with 2 or 3 regent samples of RBCs which have all the clinically impt RBC antigens

142
Q

what is a cross-match

A

mixing of donor and recipient cells occur

143
Q

What is antibody screening w/ blood

A

pt’s plasma w/ blood group “regents” expressing commonly encountered RBC antigens: Duffy, Kidd, Kell, SsU antigens

144
Q

Steps for crossmatch

A
  1. Immediate phase: check ABO typing errors (5 min)
  2. Incubation: first phase reaction products and incubating them in albumin or salt ->detect antibodies that donot cause agglutination in 1st phase (Rh)
  3. Antiglobulin phase: detects incomplete antibodies (Rh, Kell, Kidd, Duffy)
145
Q

What is added to blood for storage

A

Phosphate: buffer
Dextrose: RBC energy source
Citrate: anticoag
Adenine (possibly): helps RBC synthesize ATP

146
Q

Factors assoc w/ inc survival rate of neuroblastoma

A

extra-abd location
lower international neuroblastoma risk group score
under 18 months presentation
primary tumor
no mets
small tumor
good surgical resectability

147
Q

Anesthesia for neuroblatoma

A

-if catecholamine secreting tumors both alpha and beta blockade preop
-a line, Central line
-keep euvolemic
-BP control!!
-rapid transfusion device

148
Q

What test used for neuroblatoma dx?

A

elevated urinary catecholamines

149
Q

vaporizer output proportion of sevo, iso

A

sevo: 1/4
iso: 1/2
if 100 cc/min goes through sevo vaporizer -> 25cc of sevo

150
Q

CVP waveform interpretation

A
151
Q

CVP venous waveform

A

a: atrial contraction
c: closure of tricuspid valve
x: atria relaX
v: ventricles prepare yourself
y: yes we ready! emptYing of RA

152
Q

S4 heart sound

A

dec LV compliance (diastolic dysfxn and LVH)

153
Q

What electrolyte change assoc w/ Guillane Barre

A

Hyponatremia
-pts get SIADH
-degree of hypoNa has a relationship w/ severity

154
Q

Guillian Barre sym

A

post GI or resp illness -> autoimmune demyelinating polyneuropathy
-ascending weakness
-hypoNa (SIADH)
-DVT inc risk
-autonomic dysfxn: hypoTN, HTN, dysrhythmias

155
Q

LP for guillan barre

A

increased protein w/ normal cell ct and normal glucose

156
Q

What opioids accumulate in renal failure and what SE do they have?

A

hydromorphone and morphine, meperidine
neurotxicity -> sz

157
Q

What opioids accumulate in renal failure and what SE do they have?

A

hydromorphone and morphine, meperidine
neurotxicity -> sz

158
Q

Which opiods are assoc w/ serotonin syndrome

A

meperidine and tramadol

159
Q

Hirsutism

A

Where women start to grow hair in more manly locations: lip and on chin

160
Q

What is Cushing Syndrome

A

prolonged exposure to excess cortisol

161
Q

Symptoms of Cushing Syndrome

A

Due to exces cortisol -> massive protein breakdown -> moon faces, buffalo hump, abd weight gain, thinning of extremities
-hirsuitism (cortisol mimics androgens)
elevated blood sugar
-mood disturbances
-lytes changes: HypoK

162
Q

Triad of forgein body in trachea

A

asthmatoid wheeze, audible slap from foreign body against the trachea during ventilation, and palpable thud over the trachea

163
Q

where is foreign body w/ drooling and inspiratory stridor

A

upper airway obstruction

164
Q

Anesthesia plan for removal of an upper airway obstruction

A

-minimize agitation of pt (forced inhalation after crying can cause dynamic collapse of the airway)
-PPV cautiously to stent open airway
-parent present slow inhalation induction, topical cream to put IV in while pt lighter
-once IV deepend and CPAP
-give to surgeon
-no NMB, keep pt breathing

165
Q

Which volume expanding fluid can produce a coagulopathy at large doses?

A

Hydroxyethyl starch
Dextran

166
Q

Aldrete scale for d/x pts from Phase 1 recovery

A

Activity: moving voluntarily or on command
Respiratory: breaths deeply and coughs well
Circulation: BP w/ i 20 of preop
Consciousness: awake and alrter
O2 sat: > 92% on room air

167
Q

What age are peds required to stay overnight after anesthesia

A

if they are less than 60 weeks post-conceptual age
-inc risk of postop apnea, desat and bradycardia
***spinal decreases risk compared to GA

168
Q

13 YOM fever, sore throat, trismus and difficulty swallowing dx?

A

peritonsillar abscess
-Group A beta hemolytic Strep MCC
-trismus: pain and m spasm

169
Q

MCC of epiglottitis

A

H influenza
-NO NMB -> risk of pharyngeal m relaxation and complete airway obstruction
-remain intubation 24-48 hrs until inflammation subsides

170
Q

Renal fxn changes in elderly

A

-renal mass at age 80 dec by 30%
-RBF dec about 10% per decade
-Cr normal b/c dec muscle mass
-impaired concentrating and diluting urine -> risk of dehydration and electrolyte abnormalities

171
Q

RF for failed neuraxial anesthesia during c/s

A

increasing maternal BMI
late labor epidural placement
rapid decision to incision interval

172
Q

What fluid should be used w/ neurosurgical pts and acute neurologic trauma

A

NS
-slightly hypertonic compared to normal plasma
-greater ability to lower ICP -> brain relaxation

173
Q

What fluids in pts w/ advanced hepatic dx?

A

normal saline b/c can’t metabolize lactate from LR -> will confuse resuscitation measures

174
Q

What fluids in pts w/ ESRD

A

use LR -> they can clear the K and the hyperchloremic met acidosis from NS is worse and will inc K by a higher amount

175
Q

Strong Ion Difference Equation

A

(Na + K + Ca + Mg) - (Cl and lactate)
sum of strong cations - sum of strong anions

176
Q

Normal strong ion difference

A

~40 due to unmeasured ions (ie lactate)
-when > 0 -> alkalosis
< 0 -> acidosis

177
Q

Increasing the strong ion difference

A

alkalosis b/c SID > 0
-Inc Na -> inc SID -> alkalosis
-vomiting causes an inc b/c getting rid of a lot of Cl -> inc difference b/w cations and anions -> alkalosis

178
Q

Decreasing the strong ion difference

A

acidosis b/c SID < 0
-Dec Na -> dec SID -> acidosis
-Inc Cl -> dec SID -> acidosis
-Inc in organic acidosis like latate or ketoacids -> dec SID and acidosis

179
Q

strong ion difference w/ NS bolus

A

NONE b/c they have equal conc of Na and Cl -> no change in strong ion

180
Q

Acetazolamide MOA

A

carbonic anhydrase inhibitor
-prevents the reabsorption of bicarb -> metabolic acidosis
-accompanied by dec in CO2 to respiratory compensate
(usually results in reabsorption of Na, Cl, bicarb)

181
Q

Indications for Acetazolamide

A

glaucoma
idiopathic intracranial HTN
altitude sickness
epilepsy
periodic paralysis
CHF

182
Q

Strong ion difference in dehydration and overhydration

A

Dehydration: SID inc -> concentrates the unmeasured ions -> alkalosis
Overhydration: dilution of ions, SID decreases -> dilutional acidosis

183
Q

NSAIDs and kidneys

A

NSAIDs dec PG through inh of COX 1
-vasoconstriction on afferent arteriole and nada on efferent arteriole -> dec GFR
-can get kidney failure if chronic kidney dx, on vasopressors, or hypoTN b/c can’t get GFR high enough to perfuse

184
Q

Cold ischemia times for transplant

A

Heart: 4-6
Liver: 6-10
Lungs: 4-6
Kidneys: 24

185
Q

Causes of AG met acidosis

A

Methanol
Uremia
DKA
Propylene glycol
Isoniazid, Iron
Lactic Acidosis
Ethylene glycol, Ethanol
Salicylates (ASA)

186
Q

Muddy brown casts in urine

A

Acute Tubular Necrosis
-usually ischemia and reperfusion injury

187
Q

FENa equation

A

(UNa x PCr) / (UCr x PNa)

188
Q

FENa prerenal cutoff

A

< 1%

189
Q

Prerenal BUN: Cr ratio

A

> 20

190
Q

UNa prerenal cutoff

A

<20

191
Q

Uosm prerenal cutoff

A

> 400

192
Q

Post TURP, awake, following commands, neuro intact, Na 131 what do you do?

A

Observation
-Its <5 from normal, pt neuro intact, they have normal kidneys so the body will appropriately correct

193
Q

Post TURP pt confused, resp distress, and pts Na is 125, what do you do?

A

Fluid restrict and give IV loop diuretics
-If Na b/w 120-130

194
Q

Post TURP pt confused, neuro not intact, hypoNa 118, what to do?

A

If Na < 120 -> give hypertonic saline, stop w/ saline once Na > 120

195
Q

Inc conc of which solute in IVF is assoc w/ highest development of AKI in critically ill pts

A

Cl -> don’t use NS

196
Q

Ataxic gait disturbance, AMS, and oculomotor dysfxn guy who smells like alcohol

A

Wernicke Encephalopathy
-Thiamine def

197
Q

Lyte derangements in chronic alcoholics

A

-Low thiamine, pyridoxine, and folate
-AST> 2x ALT
-hypoglycemia -> give thiamine before glucose
-hypoCa (2/2 hypoMg can’t absorb Ca from kidney w/o Mg)
-hypoMg
-hypoPhos

198
Q

Fresh Gas Flows and acutely intoxicated adults

A

Pt will exhale alcohol, acetone, carbon monoxide and methane
-So keep your FGF higher!! to prevent rebreathing
-FGF high in intoxicated, uncompensated DM, Carbon monoxide poisoning

199
Q

Mivacurium metabolism

A

plasma cholinesterases

200
Q

Pancuronium metabolism

A

primarily by kidney (80%) -> avoid in renal failure

201
Q

Reversal of NMB and kidneys

A

Neo preliminarily limited by kidneys (50%) -> so sticks around to prevent recurarization

202
Q

Treatment for AKI

A

No one way that works -> usually supportive and let it fix itself -> give HD or CCVH if it needs help along the way
-No pharmacologic benefit
-cessation of renal insult

203
Q

Common ESRD labs

A

hyperK
hyperMg
hyperphos
hypoCa
anemia
HTN
2ndary hyperparathyroidism

204
Q

immediately post-HD labs

A

HypoK more common -> most K is intracellular -> post HD hasn’t had time to re-equilibrize yet
inc PTT from heparin AC used during dialysis

205
Q

RF for contrast induced nephropathy

A

pre-existing renal dysfunction
hypovolemia
admin of additional nephrotoxic meds
volume and type of contrast

206
Q

Periop a fib RF

A

atrial injury
ischemia
inc catecholamines
hypervolemia or hypovolemia
lyte disturbances

207
Q

Pt RF for a fib in postop period

A

male sex
advanced age
HTN
prev A fib
obesity
COPD
asthma
valvular issues
LA size
LVEF

208
Q

Best way to prevent a fib in the periop period

A

pay attention to volume status!! -> one of the biggest influences
pre-emptive rate control w/ beta blockers -> also lowers catecholamine responses to surgical stress

209
Q

Causes of metabolic alkalosis

A

GI losses: vomiting, NGT suctioning
Kidney losses: diuretics

210
Q

Prevention of contrast induced nephropathy

A

only give contrast to those who need it
give IVF

211
Q

Nephrogenic systemic fibrosis

A

gadolinium-induced contrast nephropathy in pts undergoing MRI
-MC in pts w/ kidney failure, liver transplant, hepatorenal syndrome, or acute inflammatory condition (sepsis)

212
Q

Inc risk of periop resp complications in setting of URI

A

Reactive airway dx
Prematurity
Airway surgery
ETT if pt < 5
LMA insertion
copioius secretions and nasal congestion
2nd hand smoke

213
Q

Breakdown of amino acids in body and issues w/ kidney and liver failure

A

Amino acids initially break down to ammonia -> the liver converts the ammonia to urea -> eliminated in the urine
-hepatic failure -> build up of ammonia -> asterixis and confusion w/ hepatic encephalopathy (inc ammonia)
-kidney failure -> build up of urea

214
Q

Shift of the Hg curve for anemia

A

to the RIGHT
-inc in 2,3 biphosphoglycerate and tissue acidosis

215
Q

Cryotherapy

A

relieving acute or chronic pain w/ cooling peripheral n to -50 to -70C
-induces axonal disintegration -> n disintegration lasting weeks to months

216
Q

OSA and AHI indices

A

mild: 5-15
moderate: 15-20
severe > 30

217
Q

lowest migration in CSF means

A

fastest uptake in the blood and tissues -> is the most lipophilic
ex: sufentanil in CSF

In Training Exam TL (11 decks)

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