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Apex Pt 2 > Lifespan > Flashcards

Lifespan Flashcards

1
Q

ABG changes in pregnancy

A

Ph same, 02 inc, co2 and bicarb decrease

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2
Q

Changes in preg: oxy hgb dissoc curve

A

Right shift to give 02 to fetus

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3
Q

Clotting changes in pregnancy

A

Mom makes more clot but breaks it down faster. Inc factors 1,7,8,9,10,12. Dec c+s. Inc fibrin breakdown. Dec 11,13.

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4
Q

Uterine blood flow: ml/min, %CO, dependent on what

A

700, 10. Map/co/vasc resistance, not autoregulated

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5
Q

Uterine blood flow calc

A

Uterine artery pressure-uterine venous pressure / uterine vascular resistance

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6
Q

Drug traits that favor placental transfer

A

Low molecular weight, high lipid solubility, unionized, nonpolar

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7
Q

Drugs w significant placental transfer

A

Local anesthetics, iv anes, vas, opioids, benzos, atropine, BBs, mag

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8
Q

Drugs w no placental transfer

A

Nmbs, glyco, heparin, insulin

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9
Q

Cause of early, variable, and late decals

A

Early= head comp. variable= umbilical cord comp. late= maternal acidosis and preeclampsia

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10
Q

Things that reduce fetal hr variability

A

Cns depressant drugs, hypoxemia, fetal sleep, acidosis, anencephaly, cardiac anomalies

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11
Q

Mnemonic for fetal decels

A

Veal chop

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12
Q

Tier 2 and 3 for fhr

A

2= bradycardia or tachy. Some variability. Variable decels. 3= Brady, no baseline variability, late and variable, sinusoidal pattern

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13
Q

Side effects of mag

A

Pulm edema, hypotension, skel muscle weakness, inc potency nmbs, cns dep, reduced fx of ephedrine and phenylephrine

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14
Q

Tx for too much mag

A

Calcium, diuretics

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15
Q

SE of oxytocin

A

H20 retention, low na, low bp, tachycardia (reflex), coronary vasoconstriction

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16
Q

Methergine: s/e if given iv

A

Vasoconstriction, high bp, cerebral hemorrhage

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17
Q

Hemabate: second or third line, dose, se

A

Third. 250 mcg. Nvd, low or high bp

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18
Q

Ketorolac implication in preg

A

Nsaids contraindicated after 3rd trimester, can close ductus arteriosus

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19
Q

Best trimester for pregnant pt non emergent surgery

A

Second

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20
Q

When pregnant woman needs aspiration prophylaxis. When drugs need to be given

A

Beyond 14 weeks gestation. Bicitra 30 min preop and ranitidine 1 hr before

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21
Q

Differences b/w gest htn, preeclampsia, and eclampsia.

A

All occur after 20 weeks. Gest htn just htn. Pree= +proteinura and edema. Eclampsia= +seizures

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22
Q

Pt w preeclampsia develops what in abnormal amounts, overall effect

A

More thromboxane than prostacyclin. Vasoconstriction, inc plt agg, reduced placental bf

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23
Q

Diff b/w mild and severe preeclampsia: SBP, DBP, urine diff

A

Severe= >160/110. Inc proteinura and less 24 hr urine total than 500

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24
Q

Diff b/w mild and severe preeclampsia: edema, others

A

Severe has pulm edema, both have generalized. Severe: cyanosis, h/a, visual impairment, belly pain, hellp syndrome, less plt, impaired fetal growth

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25
Q

Preeclampsia: exag response to which drugs, implication of mag to consider

A

Sympathomimetics, methergine, and nmbs. Mag inc risk of postpartum hemorrhage

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26
Q

Anes implic of maternal cocaine abuse

A

Acute intox inc mac, chronic abuse dec mac. Tx htn with vasodilators, bb may cause heart failure. Low bp may not respond to ephedrine. May have low plt, check before neuraxial

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27
Q

What happens in 3 placental implantation disorders

A

Accreta attaches to surface, Increta invades myometrium, percreta extends beyond uterus

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28
Q

Diff b/w placenta Previa and placental abruption

A

Previa= lower uterine segment, painless bleed. Abruption: separates from wall before delivery, risk of amniotic fluid emb/dic

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29
Q

Uterine atony is increased by what

A

Mu;ltiparity, multiple gestation, polyhydramnios, oxytocin infusion for awhile before delivery

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30
Q

Normal vs newborn

A

70/40, 140, 40-60 rr

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31
Q

Normal vs 1 year old

A

95/60, 120, rr 40

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32
Q

Normal vs 3 year old

A

100/65, 100, rr 30

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33
Q

What hypotension is in: newborn, 1 year old, if older than 1

A

Newborn <60. 1 y/o <70. >1=

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34
Q

Infant: breathing pattern, tongue, neck length, epiglottis shape

A

Pref nose breather, large tongue, shorter neck, epiglottis= u or omega, stiffer, longer

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35
Q

Infant: VC position, larynx location

A

VC slanted anterior, larynx c3-4

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36
Q

When peds have adult numbers of alveoli

A

8-10 years old

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37
Q

Neonate: 02 consump, avl vent, tv

A

6 ml/kg/min, 130ml/kg/min, 6 ml/kg (same as adult tv)

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38
Q

Neonatal diaphragm muscle type compared to adult

A

Less type 1 muscle fibers. Type 1= more resistant to fatigue

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39
Q

Pts at risk for apnea after surgery. Treatment

A

<60 weeks post conceptual age, should be monitored for 24 hrs after. Tx= caffeine or theophylline

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40
Q

Neonate compared to adult: FRC, VC, tlc, RV, cc, tv

A

Tv same. FRC, VC, and tlc decreased. RV and cc are higher than adult

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41
Q

Umbilical vein: ph, 02, co2. Umbilical art: ph, 02, co2

A

Vein (placenta to fetus) 7.3, 30, 40. Artery (fetus to placenta) 7.3, 20, 50.

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42
Q

Newborn abg after delivery: 10 min, 1 hr, 24 hr

A

10 min: 7.2, o2 50, co2 50. 1 hr: 7.35, 02 60, co2 30. 24 hr: 7.35, 02 70, co2 30.

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43
Q

When respiratory control matures in newborn (to hypoxemia). What happens before v after

A

44 weeks post conceptual age. Before= hypoxemia depresses vent. After= hypoxemia stim vent

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44
Q

Fetal hgb: p50, what it does to curve

A
  1. Shifts curve left to hold onto 02
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45
Q

When hgb f replaced by hgb a in baby

A

6 months

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46
Q

Hgb at: birth, 3 months, 6 months

A

17 at birth. 3= 10. 6=same as adult, 26.5

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47
Q

Transfusion trigger for rbcs if less than 4 months old

A

<13 if severe cardiopulm disease. <10 if major surgery or moderate cardiopulm disease

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48
Q

Rbc transfusion dose in <4 month old, how much it raises hgb

A

10-15 cc/kg. 1-2 g/dl

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49
Q

Ffp dose in peds

A

10-20 ml/kg

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50
Q

Plt transfusion in peds: when indicated, dose if apheresis, dose if pooled plt

A

<50k. Apheresis= 5 ml/kg. Pooled= 1 pack per 10kg

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51
Q

Neonates: how they handle water and sodium

A

Poor conservation of water and unable to excrete large volumes of water, and high insensible losses. Obligate na loser first few days of life

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52
Q

When gfr matures in peds, when renal tubular func can fully concentrate

A

8-24 months gfr. 2 years

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53
Q

When hypoglycemia signs appear in newborns. Treatment

A

<40 mg/dl if awake. 2 ml/kg 10% dextrose, 4 ml/kg if seizures. D10 gtt 8 mg/kg/min to maintain

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54
Q

How CO, VD, and PB changes in neonate affect drugs in them

A

CO inc (inc delivery and clearance), larger TBW so need higher dose of h20 sol, less albumin/a1glycoprotein if <6 month old= higher risk toxicity of Pb drugs

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55
Q

How fat content, hepatic metab, and renal clearance changes affect neonate w drugs

A

Lower fat content, longer doa if require fat for redistribution. Underdeveloped liver until 1 year old. Dec renal clearance until 2 years old

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56
Q

How MAC is diff in 1-6 months, 2-3 months, neonate, and premie

A

1-6 higher than adult. 2-3 highest level. 0-30 days lower than infant. Premie= lower than neonate

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57
Q

Mac for sevo if 0-6 months, 6months-12 years

A

0-6 higher. To 12 years lower than 0-6 but still higher than adult

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58
Q

Sux in peds: dose for neonates/infants, dose if older kid. When and how much atropine to give

A

5 mg/kg. 4 mg/kg. 0.02mg/kg if less than 5 years, definitely if second dose

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59
Q

Roc in peds: SE in peds, Im dose <1 year >1 year. Onset

A

Mild inc in hr. 1 mg/kg, 1.8 mg/kg. 3-4 min

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60
Q

Vec diff in peds

A

Longer doa

61
Q

VACTERL association of TEF in peds

A

Congenital anomalies. Vertebral defects, Imperforated anus, cardiac anomalies, TEF, esophageal atresia, renal dysplasia, limb anomalies

62
Q

Risk factors for RDS in peds

A

Low birth weight, low GA, 02 toxicity, barotrauma from PPV, ETT, maternal dm

63
Q

Lecithin to sphingomyelin ratio: ratio when adequate

A

> 2 = nml lung development

64
Q

RDS pts: where preductal pulse ox and postductal pulse ox shout led be placed. What diffference in the two could mean. Where to put a line

A

Pre= right upper arm. Post= lower extrem. Diff= pulm htn, right to left shunt, return to fetal circ via pda. Preductal a line

65
Q

Omphalocele: organ involvement, covering, incidence, coex disease, surgery urgency

A

Bowel +/- liver. Covering present. More common. Trisomy 21, cardiac defects, beckwith syndrome. Less urgent

66
Q

Gastroschisis: organ involve, covering, incidence, coex disease, surgery urgency

A

Bowel, no covering, less common. Prematurity, more urgent

67
Q

Pyloric stenosis: lyte and ph changes from vomiting

A

Low na/k/cl. Metabolic alkalosis.

68
Q

Pyloric stenosis: which way curve shifts, how kidney responds. Late complication

A

Left, less tissue 02 release. Bicarb excretion. Aldosterone release, na and h20 retained. Metabolic acidosis from lactate release

69
Q

Pyloric stenosis: intraop fluids. Postop what is common and why

A

20 ml/kg 0.9% ns, 1.5x maintenance rate of d5 0.45% ns. Postop apnea from csf remaining alkalotic

70
Q

To prevent retinal complic from 02, what spo2 should be maintained between until what age

A

85-93 up to 44 week post conception

71
Q

Where to monitor 02 sat of retinal vessels

A

Pre ductal spo2

72
Q

Drugs associated with apoptosis, how

A

IAs, nitrous, prop, ketamine, etomidate, barbs, benzos. Antagonizing or stimulating nmda receptor

73
Q

Drugs that arent associated with apoptosis

A

Opioids, precedex, xenon

74
Q

What kernicterus is, what leads to it

A

Fetal encephalopathy caused by anything that increases bilirubin

75
Q

Risk factors for kernicterus

A

Premature, low plasma protein conc, acidosis

76
Q

Epiglottitis: mechanism, age, onset

A

Bacterial, 2-6 years old, <24 hr

77
Q

Laryngotracheobronchitis (croup): mechanism, age, onset

A

Viral or rarely bacterial, <2 yr old, 24-72 hours

78
Q

Epiglottitis: area affected, ____ sign, presentation

A

Supraglottic area, thumb sign. High fever, tripod Ig, drooling, dysphoria, dyspnea, dysphagia

79
Q

Croup: region affected, ___ sign, presentation

A

Laryngeal, steeple. Mild fever, stridor, barking cough

80
Q

Treatment epiglottitis

A

02, emergency a/w mgmt, abx, cpap, induc w spont breathing, ent surgeon needs to be present, icu after sx

81
Q

Treatment croup

A

02, racemic epi, steroids, humidification, fluids, rarely needs intubation

82
Q

Dose of racemic epi for postintubation croup

A

0.5 ml of a 2.25% sol

83
Q

Risk factors post ett croup

A

<4 years old, ett to large or cuff col to high, several attempts, prolonged intubation, coughing, head or neck surgery, history of croup, trisomy 21

84
Q

Supraglottic obstruc leads to ____, infraglottic obstruc leads to ____

A

Stridor. Wheeze

85
Q

Pierre robin anomalies

A

Small mandible, tongue falls back, cleft palate

86
Q

Treacher Collins anomalies

A

Small mouth and mandible, nasal airway blockers, ocular

87
Q

Trisomy 21 anomalies

A

Small mouth large tongue atlantoaxial instab, small subglottic diameter

88
Q

Klippel feil change

A

Fusion of cervical vertebrae

89
Q

Goldenhaur and beckwith anomalies

A

Gold= small mandible and cervical spine abn. Beck= large tongue

90
Q

Cri du chat abn

A

Small mandible, laryngomalacia, stridor

91
Q

1st and 2nd most common cardiac abn in downs

A

1st is atrioventricular septal defect 2nd is VSd

92
Q

Anes consid in downs

A

Difficult ett (small mouth, big tongue, arched palate, atlantoaxial instab), c1/2 sublux (dont flex neck, get X-ray if 3-5 years old), need smaller ett, osa, chronic pulm infec, Brady common w induc. Epilepsy, gerd, flexible joints

93
Q

What is charge association

A

Coloboma (hole in eye), heart defects, Chantal atresia, retardation of growth, gu problems, ear anomalies

94
Q

What is catch 22 syndrome, other names

A

Cardiac defects, abn face, thymic hypoplasia, cleft palate, hypocalcemia, 22q11.2 gene deletion. Also called DI George

95
Q

DI George syndrome: electrolyte consid, if ___ absent at high risk of infec. Transfusion consid

A

Low ca (albumin, hypervent, and blood products may worsen this). Thymus. Leukocyte depleted irradiated blood is best

96
Q

What is 1 met

A

3.5 ml/kg/min

97
Q

What activities are equal to 1 what

A

Self care, work at computer, slowly walking 2 blocks

98
Q

What activities = 4 mets

A

Climbing a flight of stairs, 1-2 blocks uphill, light housework, raking leaves, gardening

99
Q

Which respiratory traits increase in elderly

A

Min vent, lung compliance, dead space, v/w mismatch, a-a gradient,

100
Q

Which resp traits decrease in elderly

A

Lung elasticity, pa02, lung recoil, chest wall compliance, response to inc co2/dec02

101
Q

Lung volumes that increase in elderly

A

FRC, cc, RV

102
Q

Hemodynamics in elderly: values that inc, dec, or stay same

A

Inc: BP, PP. Dec: diastolic func, SV, HR, CO. Same: SBP

103
Q

ANS changes in elderly

A

Inc sns tone, dec pns tone, dec response to catecholamines. Dec baroreceptor response, inc syncope/ortho hypo

104
Q

How mac changes in elderly

A

Dec 6% each decade after 40

105
Q

How neuraxial is diff in elderly (sensitivity to LA and intrathecal and epidural anes, response to epi, etc)

A

Inc sensitivity to all 3.dec number of nerves and diameter. Dec csf vol= greater la spread (need to dec dose). Dec response to epi test dose

106
Q

Kidney changes in elderly: renal bf, serum creat, renal , mass, creat clearance

A

Serum creat same. Gfr dec, renal bf dec 10% per decade, renal mass dec, dec creat clearance (best indicator of func).

107
Q

Kidney in elderly: gfr, response to acid load, aldosterone, adh

A

Gfr dec 1 ml/min/year after 40. Inc risk overload. Dec response to acid load, dec aldosterone (inc risk dehydration), dec response to adh

108
Q

Liver in elderly: mass, bf, periop function

A

Dec mass (less enzyme made), dec bf (less toxin delivered per time), dec func bc bf/mass not bc of hepatocellular func

109
Q

Diff and implication in elderly: a1 glycoprotein, albumin produc, psuchocholinesterase

A

Inc a1 (inc reservoir for basic drugs), dec albumin (dec reservoir for acidic rx), dec pseudocholinesterase (inc doa sux and ester las)

110
Q

Diff and implic in elderly: phase 1 rxn, phase 2 rxn, first pass metab

A

Dec phase 1, no change 2, dec first pass.

111
Q

Diff in elderly: lipophilic and hydrophilic drug response

A

Inc body fat= inc vd for lipophilic drugs, may inc DOA. Dec lean muscle mass= less body water= smaller vd hydrophilic. Higher conc per dose

112
Q

Change in elderly: protein binding and recovery from VAs

A

Inc free frac acidic drugs, dec free frac basic drugs, dec rate of recovery (inc fat and dec hepatic metab and dec gas exchange)

113
Q

Drugs w poor placental transfer tend to be what and example

A

Highly ionized. Sux, ndmrs, heparin, glyco, insulin

114
Q

Drugs w inc placental transfer tend to be what and ex

A

Lipophilic. Benzos, opioids, VAs, IV anesthetics, LAs, BBs, atropine

115
Q

Maternal and fetal SE from B2 agonist therapy

A

Mom: inc bg, dec K, inc HR. Baby: low bg after delivery, inc hr

116
Q

Fetal bradycardia is most common in which kind of neuraxial/block

A

Paracervical block

117
Q

Best time to do elective sx on preg pt

A

Second trimester

118
Q

4 abn associated with tet of fallot

A

VSd, aorta overrides PA, RV outflow tract obstruct, RV hypertrophy

119
Q

Youngest age acceptable for same day sx

A

60 weeks

120
Q

What heat transfer is ex of: covering head w plastic, incubator, foam pad on or table, humidifying gas

A

Radiation, convection, conduction, evaporation

121
Q

Which subunits are on a fetal nicotinic receptor

A

Gamma, delta, beta, 2 alpha

122
Q

What age does closing capacity exceed FRC when supine

A

45 years old

123
Q

Causes of post op delirium

A

Pneumonic= delirium. Drug use, lyte abn, lack of drug (withdrawal), infec (uti), reduced sensory input, IC dysfunc, urine ret/fecal impac, myo event and male gender

124
Q

Drug to give when Parkinson’s pt dhowing inc DA fitting in PACU

A

Benadryl

125
Q

Where are ductus venosus And arteriosus

A

Venousus= b/w umb vein and ivc. Arteriosus= b/w pa and proximal descending aorta

126
Q

How PVR and SVR different in fetal circ

A

PVR high and SVR low (unlike adults)

127
Q

When foramen ovale closes

A

When lap > rap, umbilical cord clamp. Officially over 3 days

128
Q

Ductus arteriosus: purpose, when it closes

A

Shunt blood from pulm trunk to aorta. SVR > PVR (inc pa02 dec prostaglandin). Several weeks

129
Q

Ductus venosus: purpose, when it closes

A

Allows umb blood to bypass liver, closes w umbilical cord clamping

130
Q

3 things we can effect that increase PVR

A

Light aneasthesia, tburg, and hypercarbia

131
Q

Factors that inc PVR

A

High co2, low 02, acidosis, collapsed alveoli, tburg, low temp, inc sns, light anes, pain

132
Q

Factors that decrease PVR

A

Hypocarbia, adequate 02, alkalosis, hemodilution, vasodilators, nitric

133
Q

Factors that inc SVR

A

Pressers, fluid bolus, inc sns, pain, anxiety

134
Q

Factors that decrease SVR

A

IAs, prop, dec SNS, histamine, anaphylaxis, hemodilution, sepsis

135
Q

Which shunts cause cyanosis, examples

A

R to L. 5 Ts: tet, TGA, tricuspid valve abn, truncus arteriosus, total anomalous pulm venous connection

136
Q

Right to left shunt effect on inhalation and iv inductions

A

IA: slower induc, rate of rise slower (blood bypassing lungs), more profound if less sol (des and n20). IV: faster onset, rx enters systemic circ faster

137
Q

Left to right shunt: examples

A

VSd, asd, pda, coarctation of aorta

138
Q

L to right shunt: patho and goals

A

Dec CO and BP. Inc pulm bf (pulm htn). Goal: avoid inc SVR, avoid dec PVR, dec fio2 and hypoventilation

139
Q

Eisenmengers syndrome occurs when

A

When L to R shunt pt gets pulm htn, causes flow reversal and cyanosis

140
Q

Tet of fallot defects

A

Vsd, aorta overrides RV and lv, pulm stenosis, RV hypertrophy

141
Q

Tet of fallot goals

A

Minimize r to l shunt by inc SVR dec PVR maintaining contractility and hr, inc preload

142
Q

Tet of fallot: things and drugs to avoid

A

Vasodilation (want to inc SVR), high co2/acidosis and low 02 (want to dec PVR), sns stim/ephedrine/dobutamine/epi (want to maintain hr)

143
Q

Tet of fallot: good drugs

A

Phenylephrine, nitric, esmolol, crystalloid, albumin

144
Q

Tet of fallot: best induc agent, avoid drugs that do what, ekg

A

Ketamine. Avoid histamine releasers. Right axis deviation

145
Q

Most common pediatric vs adult congenital cardiac anomaly

A

Ped= VSD. Adult= bicuspid aortic valve

146
Q

Where coarctation of aorta occurs

A

Narrowing of thoracic aorta before or after ductus arteriosus. Rarely prox to L subclavian

147
Q

Which coarctation of aorta more common in neonate v adult

A

Neonate= preductal, adult=postductal

148
Q

Coarctation of aorta: patho, what can cause hemodynamic collapse

A

Inc LV afterload, SBP elev in upper extrem and dec in Lower extrem. PDA closure

Apex Pt 2 (5 decks)

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