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ITE > ITE Truelearn > Flashcards

ITE Truelearn Flashcards

1
Q

MOCA Minute Requirement

A

120 questions per year (max 30 questions per quarter)

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2
Q

Myasthenic Crisis Treatment

A

Cholinesterase inhibitors, corticosteroids, immunosuppressant, IVIG, plasmapheresis

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3
Q

Myesthenic Gravis: postoperative mechanical ventilation indicators

A

Duration of myasthenia gravis>6 years
Chronic resp disease
Pyridostigmine >750mg/day
Vital capacity <2.9L

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4
Q

Pregnancy Coagulation factors

A

Only 2 coagulation factors decrease (XI and XIII). Other factors will increase (VII, VIII, IX, X, andXII

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5
Q

Volume Control Vent: Complications

A

Hypoxia and increased PIP in intubated ICU patients with VCV are typically caused by VILI, VAP, or auto PEEP.

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6
Q

Morbid Obesity DVT

A

Morbidly obese patients have an increased risk of DVT d/t higher circulating pro-coagulation factors

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7
Q

Tracheoesophageal fistula: ETT positioning

A

Advance ETT beyond the fistula and position the bevel of the tube anteriorly

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8
Q

Cardiac Physiology: Synchronicity

A

Aortic valve opens after Isovolumentric contraction. C-wave on CVP after the QRS complex

Mitral valve opens after isovolumetric relaxation has occurred. Which corresponds with v-wave on CVP plus T wave on ECG

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9
Q

Nausea and vomiting: Droperidol

A

D2 antagonist used as antiemetic. SE are anxiety, restlessness, akathisia, dystonia, QT prolongation.

Concern if patient has hypomagnesemia (QT prolongation)

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10
Q

Anesthetic technique: Influence on Labor

A

Neuraxial analgesia may increase duration of second stage of labor

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11
Q

CO Poisoning: Dx

A

History of elevated HbCO blood levels. Note standard pulse ox may indicate (incorrectly) a normal to high SpO2. Co-oximeter may be utilized to determine true SpO2.

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12
Q

Standard Pulse oximetry

A

Red light (660 nm) and infrared (R 940 nm)

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13
Q

Neonatal apnea hypoxemia Physiology

A

Bradycardia is thought to occur 2/2 carotid body chemoreceptor stimulation.

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14
Q

Anesthesia Complications: Sheared Catheter

A

With a retained epidural catheter tip in an asymptomatic patient, observation is considered acceptable

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15
Q

Morbid Obesity: CV effects

A

Increased adipose tissue in morbidly obese patients results in numerous CV effects. Increased total blood volume increases CO which causes increased ventricular workload. Initial decrease in SVR but RAAS and SNC increase ventricular workload. Lead to ventricular hypertrophy.

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16
Q

Newborn Emergencies: Tracheoesophageal fistula

A

Lung protective strategies (Low Vt, PEEP, low peak pressures). Secure ETT past fistula.

12 lead EKG and echo should be done prior to surgery.

17
Q

Hepatic Blood Flow: Regulation

A

Hepatic arterial buffer response (HABR) is compensatory mechanism to maintain perfusion of the liver by hepatic arterial vasodilation via reduction of portal venous perfusion.

Adenosine is released at a constant rate into fluid within the space of mall that surrounds the hepatic resistance vessels and portal venules. If blood flow is reduced in portal vein less adenosine is washed away so higher adenosine levels leads to dilation of hepatic artery.

18
Q

Neuropathic pain states: post-stroke

A

Post-stroke pain is d/t latent brain plasticity after a CVA.

19
Q

Postoperative Hepatic Dysfunction

A

The new halogenated inhalation anesthetics such as desflurane, isoflurane, and sevofluane have fewer cases of hepatotoxicity. Desflurane forms nontoxic trifluoroacetic acid (TFA), while sevoflurane forms hexafluoroisopropanol (HFIP).

20
Q

Hepatopulmonary Syndrome: Pathophysiology

A

Hypoxia in the setting of cirrhotic liver disease that is primarily due to a dysregulation of pulmonary vascular tone (resembles a large AV fistula**). Increased right to left intrapulmonary shunt and hypoxia that is resistant to increased FiO2.

21
Q

Valsalva Maneuver: Hemodynamics

A

HR decreases during valsalva d/t baroreceptor reflex.

During initial phase the transient increase in LV output 2/2 to compression of the thoracic aorta. Baroreceptor then decreases HR.

During 2nd phase: Decrease in venous return, RV and LV output, SV, MAP, pulse pressure. Baroreceptor then increase HR.

During 3rd phase: Arterial pressure decrease 2/2 thoracic aorta compression. Result in tachycardia

22
Q

Bezold Jarisch reflex

A

Triad hypotension, bradycardia, coronary artery dilation 2/2 noxious stimuli within LV

23
Q

Bainbridge reflex

A

Right atrial stretch receptors. Vagal afferent signals to the medulla cause inhibition of PNS result in tachycardia

24
Q

Propofol: Indications and CI

A

CI: soybean oil, glycerol, lecithin.

Formulation of lecithin emulsion formulation of soybean oil, glycerol, egg phosphide

**note egg white (egg albumin) is most common allergy not the egg lecithin (egg yolk).

25
Q

Popliteal fossa: artery location

A

Popliteal artery is medial and sciatic nerve is lateral. Dividing is the common peroneal nerve.

Medial to lateral: Popliteal artery, popliteal vein, tibial nerve, common peroneal nerve.

26
Q

Muscle Relaxation: Anes Agents

A

Volatile anesthetics cause muscle relaxation through inhibition of acetylcholine receptor sensitivity and through hyper polarization of motor neurons

27
Q

Volatile Induction: Neonate

A

Greater fraction of CO that is distributed to vessel rich organs in neonates. Result in more rapid onset of anesthesia.

28
Q

Etomidate: Respiration Effects

A

Depresses airway reflexes (less so than propofol), relaxes smooth muscle in the pulmonary vascular system, does not induce histamine release

29
Q

Anticoagulants: effects on PT and PTT

A

Intrinsic pathway (PTT): Enoxaparin (AT3 inactivates FXa), Unfractioned heparin

Extrinsic pathway (PT)

Dabigatran (Direct thrombin inhibitor): Increases PT and PTT

Rivaroxaban (Direct factor XA inhibitor): Increase PTT

30
Q

Onset and duration of action of vecuronium in the elderly

A

Similar potency, increased duration of action, possibly longer onset of action

31
Q

Drug Intoxication: Insecticides

A

Organophosphates inhibit both acetylcholinesterase and butyrylcholinesterase causing an increase of acetylcholine in both in nicotinic and muscarinic synapses.

Cholinergic signs: Miosis (constriction), bronchoconstriction, lacrimation, salivation, muscle weakness, diarrhea, emesis

32
Q

Propofol: other organ effects

A

Neurp: decrease CMRO2, CBF, ICP, hypnotic (GABA A R and NMDA), increase dopamine causing euphoria
Resp: Dec ventilation, bronchodilator

33
Q

Stress Response: Lipolysis

A

Lipolysis is increased by B2 and B3 stimulation but is inhibited by alpha 2 stimulation

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