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Anesthesia Oral Boards > Know Cold > Flashcards

Know Cold Flashcards

1
Q

Cushings triad

A

bradycardia, irregular respirations, and widened pulse pressure as a result of an acute increase in ICP.

Do things to decr ICP:
mannitol/lasix
raise head of bed 30 degrees
hyperventilate
insert drain
deepen anesthetic

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2
Q

Contraindications to nitrous?

A

PHTN
known air bubble
untreated pneumothorax

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3
Q

Pathophysiology of TURP syndrome?

A

absorption of dilute fluids into the circulation

if hyponatremia with no neuro symptoms: give saline and lasix

if hyponatremia WITH neuro symptoms: give hypertonic fluids slowly to avoid cerebral pontine myelinosis

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4
Q

Implication of HTN?

A

shifts cerebral autoregulation curve to the right

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5
Q

how to manage venous air embolism?

A

100% oxygen, positive pressure ventilation, and flood field with saline, then support circulation

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6
Q

change in potassium?

A

first think are there ANY EKG CHANGES? otherwise unlikely that it needs to be corrected preop

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7
Q

Mechanism and treatment of ocular mediated bradycardia?

A

vagus nerve is the EFFerent pathway

treatment:
surgeon should release retraction
atropine, epinephrine
infiltration of the muscle with lidocaine

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8
Q

What to do if there is recall?

A

Check the anesthetic record
listen with sympathy
discuss things that can be improved
offer counseling

Increased incidence in trauma, OB, female gender, and cardiac cases

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9
Q

hypothermia and shivering: what to do?

A

meperidine or other options include clonidine, dexamethasone, tramadol, propofol, alfentanil, sufentanil

forced air warming
increase ambient room temp
warm IV fluids
blankets

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10
Q

what to do if inspired CO2 is high?

A

inspiratory valve is stuck open
CO2 absorber is exhausted

change out absorber, replace valve or temporize by increasing fresh gas flow

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11
Q

problem with EMLA?

A

methemoglobinemia

treat with methylene blue
treat with ascorbic acid if G6PD deficiency

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12
Q

abdominal pain in sickle cell anemia?

A

splenic sequestration – this is an impending transfusion emergency – get IV access and type and cross

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13
Q

What is heard on the doppler if there is a VAE?

A

mill wheel murmur

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14
Q

Anytime you correct hyponatremia, worry about ______?

A

central pontine myelinolysis

correct hyponatremia with hypertonic saline no faster than 1-2 mL/kg/hr and stop once Na =125

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15
Q

therapeutic Mg level?

A

4-8 mg/dL

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16
Q

TIVA or inhalational anesthesia for one lung ventilation?

A

Either but TIVA with propofol may have a slight advantage because volatiles inhibit hypoxic pulmonary vasoconstriction.

17
Q

signs/symptoms of cocaine toxicity

A

Tremors, dilated pupils, conjunctivitis, EKG changes

18
Q

cancer pain treatment with limited expected lifespan?

A

Combination of….
non-opioids
adjuvants
+/- opioids dependent on level of pain control
(PO preferred but can be IV or SC)

if still inadequate pain control or intolerable side effects from PO meds:
intrathecal pumps
spinal column stimulators
neurolytic blocks

Adjuvant meds include:
TENS units, lidocaine patches, gabapentin, anticonvulsants, TCAs, bisphosphonates (for bony mets)

19
Q

treatment for torsades?

A

Mg therapy, isoproterenol, replete K

20
Q

EKG changes with hyPeRK, hyPeRCa, hyperMg?

A

prolonged PR, prolonged QRS, short QT

(opposite with hypoK, Ca, Mg so short PR, short QRS, widened QT)

21
Q

Management of hyperkalemia intraop?

A

Calcium to stabilize cardiac membranes
insulin/glucose
hyperventilation
bronchodilator
lasix

22
Q

indicators of difficult mask ventilation?

A

MOANS

  1. Mask fit difficult (beard, blood, trauma, syndromic facies)
  2. Obesity (BMI >26)/ Obstruction
  3. Age >55
  4. No teeth
  5. Stiff lungs/chest wall/
  6. Etc (tonsils, polyps, trauma)
  7. Prior anesthetic record
23
Q

> 50% decrement in SSEP
or >65% decrement in MEP…

WWYT?

A
  • surgical instrumentation
  • change in anesthetic levels
  • HoTN, decrease in arterial pressure below the levels of cerebral autoregulation
  • Hypoxia
  • hypercarbia
  • Hct <15% (anemia)
  • Hypothermia
24
Q

hypotension with transfusion…WWYT?

A

CASH-TO

  • Citrate Intoxication/hypoCalcemic
  • Anaphylactic/oid
  • Sepsis- “dirty blood”
  • Hemolysis -Acute Txf Rxn/ ABO Incompatibility
  • TACO/TRALI
  • Ongoing Bleeding
25
Q

STOP BANG

A

> 4 = high risk OSA

Snores
Tired daytime
Observed (gasping/choking)
Pressure (HTN)

BMI > 35
Age > 50
Neck circumference > 43 centimeters male or
41 centimeters female
Gender male

26
Q

LAST dosing (bolus vs. infusion vs max vs epi)

A

Lipid bolus: 1.5 mL/kg
infusion: 0.25 mL/kg/min
Repeat bolus if pt remains unstable
Max dose: 12 mL/kg
Epi dose for ACLS: start <1 mcg/kg
Continue infusion for 15 min after stable BP

Monitor for 2 hours after seizure
Monitor for 4-6 hours after cardiac instability
Monitor as appropriate for cardiac arrest

27
Q

problems related to hypothermia?

A

poor wound healing, coagulopathy, cardiac dysrhythmias, and imparied renal function

**inconclusive evidence for brain protection 2/2 decreased CMRO2

28
Q

DDx for bilat pulmonary infiltrates?

A

ARDS
Aspiration pneumonitis
cardiogenic pulmonary edema
neurogenic pulmonary edema
TACO/TRALI

29
Q

Cvp in setting of mechanical ventilation

A

Less reliable in assessing volume status 2/2 decr preload

30
Q

CRF induced hyperK in setting of cadaveric kidney transplant

A

Correct to normal to prevent hyperkalemic arrest during reperfusion.

31
Q

AW bleeding

A

Could lead to laryngospasm, bronchospasm, neg pressure pulm, and even loss of airway. Call for difficult AW cart and cric kit!

32
Q

uterine relaxants vs uterine tocolytics

A

uterine relaxation (retained placenta, uterine inversion or exit procedure):
beta 2 agonists: terbutaline, ritodrine
magnesium
volatile agents
nitroglycerine

tocolysis:
mag
indomethacin
nifedipine
beta 2 agonists: terbutaline, ritodrine

33
Q

ACLS in pregnancy

A

chest compressions higher on the sternum
LUD
discontinue Mg
Give calcium to stabilize myocardium
Baby out if no return of ROSC after 4 minutes

Anesthesia Oral Boards (4 decks)

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