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Advanced Health Assessment - Leersnyder > leersnyder day 2 > Flashcards

leersnyder day 2 Flashcards

0
Q

most reliable source of info about your patient

A

the patient

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1
Q

three vanderbilt computer interfaces

A

vpims, vpimsweb, starpanel

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2
Q

if a preop was templated and has the physical exam filled out, is it complete?

A

no

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3
Q

What is the name of the diagnosis and procedure codes in the US?

A

icd9, icd10, CPT

Also the codes for the dx must match between anesthesia and surgery or no reimbursement.

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4
Q

which of the following is NOT a redflag for preops?

  1. aicd/pacer
  2. OSA
  3. mild pulm htn
  4. new stents
A
  1. mild pulm HTN
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5
Q

state risks associated with REGIONAL anesthesia and their incidence

A

prolonged numbness/weakness, post-dural headache, failure of technique

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6
Q

state at risk populations

A

extremes of age, redheads, drugs and alcohol, chronic pain patients, enzyme induced patients, genetic variances (MH)
Watch out for the old drunk redhead who goes to the methadone clinic and has a genetic predisposition to malignant hyperthermia.

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7
Q

state strategies to minimize risk

A

avoid full stomachs, emergency surgery, cardiac problems, emergency c-section (high risk of general anesthesia, high risk of loss of airway and aspiration), light anesthesia = recall (risk of PTSD, use a BIS), maintain anesthesia equipment and competency.
Don’t do an EMERGENT C-SECTION on the patient who just ate 14 KRYSTALS and has new onset A-FIB if your BIS monitor and anesthesia MACHINE aren’t working.

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8
Q

sore throat

A

50%

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9
Q

hoarseness

A

15-50%

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10
Q

post op N/V

A

10-80%

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11
Q

drowsiness/confusion - emergence delirium vs. POCD (postop cognitive dysfunction)

A

age dependent

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12
Q

operative awareness

A

less than 1%

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13
Q

neuromuscular blocker MOST OFTEN associated with anaphylactic reaction

A

succs

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14
Q

states with HIGHEST INCIDENCE of malignant hyperthermia

A

Wisconsin, Nebraska, West Virginia, Michigan

Willy Nelson wears virgin Miche

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15
Q

visual loss

A

less than 0.056%

1/20th of 1%

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16
Q

aspiration incidence

A

highest in pregnancy

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17
Q

drug reactions

A

1:13,000

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18
Q

number 1 drug reaction in US

A

antibiotics

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19
Q

death

A

1:10,000

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20
Q

in surveys patients are most concerned about

A

post op pain, N/V, not waking up, drains and needles

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21
Q

triple low phenomena

A

low MAC, low MAP, low BIS

4x greater mortality over 30 days

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22
Q

infection incidence post regional

A

3:65,000

You have a 1:22,000 chance

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23
Q

persistent numbness / weakness

A

1:4,343

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24
Q

seizures post regional

A

0.022%

Like if you accidentally shot yourself in with a tenth of a .22 pistol, you wouldn’t die you’d just have a seizure

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25
Q

overall cardiac arrest rate overall vs anesthesia related

A

3/100 vs 1/1,000

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26
Q

overall critical events vs anesthesia related

A

964/10,000 vs 64/10,000

Minus 900 critical events

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27
Q

overall mortality rate vs anesthesia related

A

463/10,000 vs 4/10,000

Minus 460 deaths

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28
Q

_____ was mainly responsible for CRITICAL EVENTS in patients with GOOD physical status, but _____ diseases were mainly responsible in those with POOR physical status

A

anesthetic management

coexisting diseases

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29
Q

we kill the ASA __ and __, the __ and __ kill themselves

A

1, 2, 3, 4

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30
Q

____ fold increase in critical events for ASA 4’s non-emergency vs. emergency surgery

A

four (148:10,000 compared to 592:10,000)

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31
Q

anesthesia related deaths due to ADVERSE EFFECTS OF ANESTHETICS

A

42.4%

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32
Q

WHO MOST COMMONLY DIES DURING SURGERY?

A

MALES (80%), age 25-54 (55%), lowest death rate (5-14 years), highest death rate (age 85 or older)

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33
Q

In the USA between 1999-2005, 1,030 people died of anesthesia related complications to what?

A

overdose of anesthetic

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34
Q

In Japan study emergency surgery for an ASA4 patient increases the risk of anesthesia complications by what factor?

A

four times the risk

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35
Q

In Japan what was the leading cause of CRITICAL EVENTS of people with good physical status?

A

anesthetic management

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36
Q

In Japan what was the leading cause of critical events in those with poor physical status?

A

coexisting diseases

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37
Q

HPI

A

history of present illness

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38
Q

In the US mortality due to anesthesia is higher in what gender?

A

males

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39
Q

percentage of deaths caused by adverse effects?

percentage of deaths caused by anesthetic overdose?

A
  1. 4% adverse effects

46. 5% anesthetic overdose

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40
Q

what are some red flags in preop?

A

MI within last 6 mo’s, chest pain, stents, new EKG changes

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41
Q

what is the fastest growing surgical specialty?

A

interventional radiology for neuro

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42
Q

a basic neuro exam should include…

A

oriented x4, deficits do not impair communication or comprehension, eyesight, pupils, visual fields, motor or sensory impairment

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43
Q

what is the NIHSS stroke score

A

42 point scale to identify deficits, 0 = no deficit, 42 = worst deficit, score defines 30 day mortality rate

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44
Q

what is hunt and hess scoring?

A

grading scale for subarachnoid hemorrhage
grade 1 - minimal headache
grade 2 - mod to severe HA, nuchal rigidity, cranial nerve palsy
grade 3 - drowsy
grade 4 - stuporous, mod to severe hemiparesis
grade 5 - deep coma, decerebrate rigidity

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45
Q

three interventional radiology treatments for a clot

A

penumbra, solitaire, trevo pro

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46
Q

three interventional radiology treatments for an aneurysm

A

glue, coil, clip

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47
Q

fourth leading cause of death and first leading cause of disability

A

stroke

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48
Q

three drugs that dissolve a clot

A

integrillin, TPA, reopro

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49
Q

EBUS stands for __

A

endobronchial ultrasound

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50
Q

american cancer society rates lung cancer the ____ cancer in the US

A

2

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51
Q

two possible airway effects of the asthmatic in the OR

A

bronchospasm, laryngospasm

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52
Q

best anesthetic gas for reactive airway?

A

sevo

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53
Q

s3 murmur

A

heart failure

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54
Q

most feared respiratory complication in anesthesia?

A

aspiration pneumonia

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55
Q

what is the PCI goal for STEMI

A

90 minutes

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56
Q

6 p’s of arterial insufficiency

A

pain, pallor, pulselessness, parasthesia, paralysis, perishing cold

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57
Q

what percentage of non cardiac surgical patients suffer a cardiac morbidity

A

1-5%

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58
Q

what does the first heart sound represent

A

closure of mitral and tricuspid valve

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59
Q

Most common cause of acute liver failure

A

tylenol OD

60
Q

what is the gold standard test for cardiac function

A

treadmill stress test

61
Q

most common complication of cirrhosis?

A

fatigue

62
Q

most common drug induced hepatitis?

A

tylenol

63
Q

liver disease is reflected by what labs

A

increased total bili, increased ast, alt, decreased albumin, increased PT

64
Q

major cause of m and m in the pt with cirrhosis

A

bleeding from esophageal varices

65
Q

what two labs best evaluate liver dz

A

serum albumin and PT

66
Q

surgical risk is greater in a patient with the following 5 factors

A

high bili (>3g/dL), severe ascites, coma, poor nutritions, low albumin <3g/dL

67
Q

concerns with morbidly obese patients

A

iv access, airway obstruction, metabolization of drugs, solubility of drugs

68
Q

a low albumin (half life 20 days) reflects acute or chronic liver dz?

A

chronic

69
Q

what is your primary concern with a tooth abscess?

A

airway

70
Q

which class of drugs should you avoid in a patient with a history of ulcers?

A

nsaids

71
Q

what should you check in a patient with GI symptoms?

A

frequency, recent EGD, how many pillows, treatment and efficacy, hemoptysis

72
Q

what is a whipple?

A

resection of antrum of stomach, duodenum, gall bladder, and head of pancreas

73
Q

name four issues with morbid obesity?

A

IV access, drug metabolism, difficult airway, use insoluble gas (des), loss of functional reserve capacity

74
Q

what is a major risk factor of a patient with a bowel obstruction?

A

vomiting

75
Q

leading cause of kidney disease in the US?

A

diabetes

76
Q

how much kidney function can you lose before symptoms begin

A

you can lose 80%

77
Q

which of the following electrolytes are affected by CRF?

A

hyperK, hyperMAG, hyperPHOS, hypoCALC

78
Q

why are chronic renal patients anemic?

A

healthy kidneys secrete erythropoetin, anephric patients do not,
also reduced iron intake from dialysis diet leads to ironn-deficiency anemia

79
Q

in order to differentiate pre renal (decreased renal perfusion) from acute renal failure (tubular damage) what test might you order?

A

fractional excretion of filtered sodium, if 1% = obstructive renal failure (ATN)

80
Q

coagulopathy in CRF leads to what four sites of bleeding?

A

GI ulcers, epistaxis (nose bleeds), subdural hematoma, hemorrhagic pericarditis

81
Q

Features of a child’s airway vs. adults are

A

funnel-shaped larynx

82
Q

number one cancer in kids

A

leukemia

83
Q

t/f it is important to discuss risks of anesthesia in front of children?

A

false

84
Q

Most common cancer in children

A

leukemia

85
Q

recent studies have shown that infants have___ (more/less) sensitivity to pain

A

increased sensitivity to pain

86
Q

oxygen consumption of an infant is ___ that of an adult?

A

twice

87
Q

what is the fastest growing endocrine disease in the US?

A

diabetes

88
Q

almost all pediatric codes are due to

A

respiratory distress

89
Q

what needs replaced after a parathyroidectomy?

A

calcium

90
Q

what does MEN syndrome stand for?

A

MEN- multiple endocrine neoplasm

91
Q

nerve damage / paralysis post regional

A

0.2 - 0.4 %

92
Q

Box 19-12 surg risk estimates

HIGH >5% cardiac risk

A

Aortic
Major vascular
Peripheral vascular

93
Q

Box 19-11 active cardiac conditions that require further eval before non-cardiac surgery

A 
Unstable or severe angina
MI within 30 days
High grade block
Symptomatic ventricular arrhythmia
SVT >100 bpm
Symptomatic bradycardia
New v-tach
Aortic stenosis (pressure >40, area 2mg/dl
94
Q

Box 19-12 surg risk estimates

LOW <1% cardiac risk

A

Breast Dental Endo Endo Superficial Cataracts Gyn Reconstructive MinOrtho MinUro

95
Q

Box 19-12 surg risk estimates

INTERMEDIATE 1-5% cardiac risk

A 
Intra peritoneal / thoracic
Transplant
Carotid
Peripheral arterial angioplasty
Endovasc aneurysm repair
Head and neck
Major neuro / ortho / uro
96
Q

S/s cocaine and amphetamines

A

Tachycardia, labile BP, HTN, MI, arrhythmia, pulm edema, excitement, delirium, hallucination, psychosis, euphoria, hyperreflexia, tremors, convulsions, mydriasis, sweat, fever, exhaustion, coma

97
Q

S/s of marijuana

A

Tachycardia, labile BP, headache, euphoric, dysphoric, depressed, poor memory and decreased motivation, rare anxiety panic or psychosis.

98
Q

S/s of opiod abuse

A

Resp depression, hypotension, bradycardia, constipation, euphoria, pinpoint pupils, coma.

99
Q

S/s hallucinogens: LSD, PCP

A

Sympathomimetic, weak analgesia, altered perception and judgement, dissociative anesthesia with increasing doses.

100
Q

Most common female adult cancer

A

Skin, breast is second

101
Q

Most common male adult cancer

A

Skin, Prostate is 2nd

102
Q

Leading cause of cancer DEATH in both male and female

A

Lung

103
Q

what gland is often removed in pediatric congenital heart surgery?

A

thymus

104
Q

what are the symptoms of thyroid storm?

A

increased heart rate, temp, and basal metabolic rate

105
Q

Patients with cancer have a __ fold increase in VTE, but __ if treated with chemo

A

4 fold cancer alone, 7 fold if treated with chemo

106
Q

Cancer is the __ most common cause of death in US

A

2nd

107
Q

Japanese study- leading causes of mortality in patients with GOOD physical status

A

Procedures and massive hemorrhage

108
Q

Japanese study- mortality attributed to anesthesia

A

7/10,000

109
Q

Five major differences between peds and adults

A 
Larynx more cephaladad
Relatively large tongue
Angled vocal cords
Long stiff U shaped epiglottis
Funnel shaped larynx narrowest at cricoid cartilage
110
Q

Oxygen consumption of infant is __ that of an adult per kg/min

A

Twice

111
Q

OB- leading cause of maternal mortality in US

A

Thromboembolic events / PE

112
Q

OB- RSI only after __ weeks

A

12

113
Q

What is a normal change of pregnancy

A

Increase in cardiac output

114
Q

In the US how many pregnant women have surgery not related to delivery?

A

1 in 50

115
Q

What is a red flag related to pregnancy?

A

Proteinuria and elevated LFTs

116
Q

According to the AANA guidelines the primary responsibility of the CRNA is to the NEONATE post delivery?

A

False

117
Q

How many people for a log roll

A

4

118
Q

most common heart murmur

A

mitral regurge

119
Q

most serious heart murmur

A

aortic stenosis

120
Q

s3 murmur indicative of

A

heart failure

121
Q

which is not a redflag for preops

A

mild pulm hypertension

122
Q

murmur best heart in the 2nd right intercostal space with transmission into the neck

A

aortic stenosis

123
Q

critical aortic stenosis

A

less than 0.6 cm squared

124
Q

sudden death in young athletes

A

hypertrophic cardiomyopathy

125
Q

diagnostic gold standard for pulmonary HTN

A

right heart cath

126
Q

treatment for pulm hypertension

A

flolan

127
Q

gold standard for coronary artery disease

A

coronary angiography

128
Q

bare metal stents recommendation for elective surgery

A

6 weeks

129
Q

drug eluting stents recommendation for elective surgery

A

one year

130
Q

how long after MI before having non-cardiac elective surgery

A

6 months

131
Q

What drug killed Michael Jackson

A

Jackson Juice

132
Q

most common cancer in US males after skin cancer

A

prostate

133
Q

most common cancer US females after skin cancer

A

breast

134
Q

chemo agent associated with pulmonary fibrosis

A

bleomycin

135
Q

chemo increases risk of PE by __ fold

A

7 fold

136
Q

ABCDE

A 
airway and c spine
breathing and ventilation
circulation and hemorrhage control
disability and neuro assessment
exposure and environment
137
Q

goal of surgeon during level one operation

A

get in, get out

138
Q

how to perform a log roll

A

4 people

139
Q

HELLP

A

hemolysis, elevated liver ‘zymes, low platelets

140
Q

first stage of labor, pain neurons enter cord at level

A

T10-L1

141
Q

second stage of labor, pain through neurons enter cord at level

A

pudendal nerve, S2-S4

142
Q

most common cause of maternal morbidity

A

thromboembolic events / PE

143
Q

INR >2

A

cancel surgery

144
Q

what does a pheochromocytoma secrete?

A

catecholamines

145
Q

what gland is resected through the nose?

A

pituitary

146
Q

beck’s triad associated with cardiac tamponade

A

low BP, JVD, muffled heart sounds

147
Q

pulsus paradoxus

A

associated with cardiac tamponade

148
Q

Mendelson syndrome

A

chemical pneumonitis caused by aspiration during anaesthesia, especially during pregnancy.

Advanced Health Assessment - Leersnyder (2 decks)

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