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M5 Flashcards

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1
Q

Why does a patient desaturates 5 min after retrobulbar block

A

Local anesthetic in CSF causing high spinal

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2
Q

Next best step in treatment of patient with likely corneal abrasion

A

Topical antibiotics

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3
Q

Protopathic sensation

A

Noxious (painful)

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4
Q

Epicritic sensation

A

Non-noxious (touch, pressure, temperature, proprioception)

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5
Q

Nociceptive pain is caused by activation of what type of receptors

A

High threshold peripheral nociceptive receptors

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6
Q

Nociceptive pain is transmitted via what types of nerves

A

A-delta and C nerve fibers

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7
Q

Pain fibers enter spinal cord via which nerve roots?

A

Mostly dorsal nerve root but some enter via ventral nerve root

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8
Q

Primary area of pain pathway that opioids act upon

A

Dorsal horn where 1st order neurons synapse with 2nd order neurons

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9
Q

How is resistance to flow related to length and radius?

A

Resistance proportional to 8 times length

Resistance inversely proportional to radius to 4th power

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10
Q

What’s an intrinsic property of a transplanted lung that is kept intact?

A

Hypoxia pulmonary vasoconstriction

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11
Q

Which procedure is hypotension most likely, insertion of venous cannulation or insertion of aortic cannulation?

A

Venous cannulation can significantly reduce preload

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12
Q

What are advantages to off pump cabg?

A

Decreased incidence of respiratory infection and afib postop, less inotrope use, fewer blood transfusions

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13
Q

Mechanism of heparin

A

Binds to anti-thrombin 3, which accelerates inhibition of thrombin and factors 9 and 10

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14
Q

Next best step if heparin causes no change in ACT prior to CPB

A

Give 2 units of ffp then give heparin. Pt likely has anti-thrombin 3 deficiency

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15
Q

Functions of thromboxane

A

1) Platelet aggregator, facilitating clot formation. 2) Vasoconstrictor that reduces blood flow to site of clot

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16
Q

Pulmonary artery pressure rise after protamine administration for heparin reversal

A

Heparin protamine complexes can cause thromboxane release from macrophages

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17
Q

Hypotension after protamine administration for heparin reversal

A

Dose dependent histamine release from mast cells

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18
Q

Best way to decrease time to rewarm patient

A

nitroglycerin infusion

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19
Q

Fast pain is carried by what type of nerve fibers?

A

A delta fibers (myelinated)

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20
Q

Delayed slow secondary pain is carried by what type of nerve fibers?

A

C fibers

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21
Q

Induction agents except for ketamine work on which type of GABA receptor?

A

GABA-A receptor

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22
Q

Propofol should be discarded after being drawn into a syringe after how many hours?

A

12 hrs, it used be 6 hrs before EDTA preservative was added.

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23
Q

What part of egg is used in propofol?

A

Egg lecithin from the egg yolk. People allergic to eggs are allergic to egg albumin which is in egg white.

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24
Q

Pretreatment with what drug can decrease etomidate associated myoclonus?

A

Opioids

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25
Q

Reason why etomidate causes burning pain

A

Propylene glycol solvent that etomidate is in

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26
Q

Etomidate causes increase in ICU mortality because of?

A

Prolonged infusions causing adrenal suppression

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27
Q

In what percent of patients does a single induction dose of etomidate cause adrenal suppression?

A

All patients

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28
Q

Hydrophilic or lipophilic drug has smaller volume of distribution

A

Hydrophilic

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29
Q

Induction agent that is completely metabolized by liver on a single pass

A

Propofol

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30
Q

2 pathways signaled by G protein coupled receptors

A

1) cAMP -> PKA

2) phospholipase C -> IP3

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31
Q

Where is propofol metabolized?

A

Liver and lung

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32
Q

How is fospropofol different than propofol?

A

Water soluble, prodrug that has to be metabolized by liver to release propofol and formaldehyde

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33
Q

How does barbiturates affect tolerance to pain?

A

Decrease tolerance to pain

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34
Q

Barbiturate injected in artery causes?

A

Limb gangrene due to arterial spasm and vasoconstriction, treatment is stellate ganglion block

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35
Q

Morphine metabolite

A

Morphine-6-gluconoride, major contributor to mu receptor mediated respiratory depression

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36
Q

Oversized BP cuff affects BP measurement how

A

BP will be underestimated

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37
Q

Correlation between central venous pressure and left ventricular end diastolic volume

A

None at all

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38
Q

Betadine or chlorhexadine use has lesser catheter related bloodstream infection

A

Chlorhexadine

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39
Q

How does insulin affect glycogen and protein synthesis?

A

Increases

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40
Q

Hypernatremia or hyponatremia is associated with hypothyroidism?

A

Hyponatremia: hypothyroid patients retain free water

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41
Q

Classic diuretic of choice to treat Cushing’s syndrome

A

Spironolactone

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42
Q

Anesthetic considerations with Cushing’s syndrome

A

Increased sensitivity to muscle relaxants, hypokalemic arrhythmias, difficult intubation for obesity and swelling

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43
Q

Healthy person can produce up to how much cortisol in a day when maximally stressed

A

300 mg of cortisol

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44
Q

Historically why is succinylcholine contraindicated with pheochromocytoma pts?

A

Supposedly fasciculations cause catecholamine release secondary to abdominal pressure

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45
Q

Historically why is pancuronium contraindicated with pheochromocytoma pts?

A

Pancuronium is vagolytic

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46
Q

Pheochromocytoma is associated with which syndromes?

A

MEN2A, NF1, Von Hippel-Landau

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47
Q

How are anaphylactoid reactions different from anaphylaxis?

A

Anaphylactoid reactions are NOT IgE mediated

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48
Q

MC type of vWD

A

Type I

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49
Q

Type of vWD that responds to DDAVP

A

Type I

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50
Q

One unit of plasmapheresis platelets will raise platelet count by how much?

A

60,000 because 1 unit equals a 6 pack of pooled platelets which comes from 6 donors

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51
Q

Cryoprecipitate contains what factors?

A

Factor 8, fibrinogen, vWF

52
Q

Washing RBCs prevents what?

A

Anaphylaxis in IgA deficient patients by removing IgA from RBCs

53
Q

Leukodepletion or leukoreduction of RBCs prevents what?

A

Febrile reactions and alloimmunization

54
Q

Irradiation of blood products prevents what?

A

Graft vs host disease, irradiation destroys DNA

55
Q

Febrile transfusion reaction is caused by?

A

Recipient antibodies toward donor WBCs

56
Q

Post transfusion purpura is caused by

A

Immunologic complication towards platelet surface proteins presenting with thrombocytopenia a week after transfusion, very uncommon.

57
Q

Typical onset of TRALI is within how many hrs?

A

2 hrs

58
Q

Typically TRALI resolves within how many hrs?

A

48

59
Q

What is the 2 hit theory of TRALI?

A

1) sequestration of neutrophils in lungs

2) activation of neutrophils and immune response causing transient leukopenia

60
Q

Transfusing 4cc/kg of prbcs will raise hgb by how much?

A

1 g/dL

61
Q

Blood volume for premature neonate

A

100 mL/kg

62
Q

Blood volume for full term neonate

A

85 mL/kg

63
Q

Blood volume for infant/toddler

A

75 mL/kg

64
Q

Blood volume for adult

A

60-70 mL/kg

65
Q

Risk of hep B infection from blood transfusion

A

1:200,000

66
Q

Risk of hep C infection from blood transfusion

A

1:2,000,000

67
Q

Risk of HIV infection from blood transfusion

A

1:2,000,000

68
Q

Nerve root that provides motor innervations to triceps and back of hand and middle finger

A

C7

69
Q

Nerve root that when damaged causes numbness of medial forearm and fifth finger and weakness in finger flexion

A

C8

70
Q

Ulnar nerve injury is characterized by?

A

Handgrip weakness and fifth finger numbness

71
Q

Main advantage of retrobulbar block over peribulbar block

A

Decreased onset time of block

72
Q

Half life of dabigatran

A

12 hrs

73
Q

Preop instructions regarding herbal meds that cause increased risk of bleeding

A

Discontinue 1 week prior to surgery

74
Q

Herbal med that interferes with warfarin

A

Ginseng

75
Q

When do u stop giving 100% oxygen to patient with carbon monoxide poisoning?

A

When asymptomatic and carboxyHb is below 10%. 100% Oxygen shortens elimination half life by 5 times, hyperbaric oxygen by 10 times

76
Q

Vapor output equation for a given gas flow and vapor pressure of anesthetic gas

A

Vapor output = (CG X SVP) / (Pb - SVP)

CG = carrier gas flow
SVP = saturated vapor pressure
Pb = atmosphere pressure
77
Q

Which partition coefficient is necessary for calculation of time constant for volatile anesthetics?

A

Brain/blood partition coefficient. Time constant equals double the coefficient

78
Q

Midazolam, fentanyl, barbiturates are water or lipid soluble?

A

Lipid soluble.

79
Q

Obese patient should be induced with propofol based on what type of weight?

A

Ideal body weight. Propofol infusion should be based on total body weight

80
Q

Proportion of sodium filtered by glomerulus that is typically excreted in the urine

A

5%

81
Q

Treatment for acute interstitial nephritis

A

Steroids

82
Q

Digoxin toxicity symptoms

A

Ventricular arrhythmias, malaise, vision changes

83
Q

For every increase of glucose of 100 mg/dL, the measured sodium falls by how much?

A

1.6 mEq/L

84
Q

Normal value for urine sodium

A

Less than 20 mEq/L

85
Q

Loss of cold discrimination under epidural anesthesia is how many levels above level of anesthesia?

A

2 dermatomes

86
Q

Major side effect of methergine

A

Hypertension (rhymes with methergine)

87
Q

Major side effect of hemabate

A

Bronchospasm (avoid in asthmatics)

88
Q

Ephedrine effect on fetus

A

Increases fetal metabolism and oxygen consumption

89
Q

Active phase of labor affects which nerve roots and what type of nerve fibers account for pain

A

Lumbar nerve roots, small visceral afferent fibers

90
Q

Side effect of ketorolac in pregnancy

A

Theoretical closure of ductus arteriosus, increased bleeding. Ketorolac is relatively ineffective to treat labor pain

91
Q

Mortality of pregnancy in patient with eisenmenger’s syndrome

A

30-50%

92
Q

Narcotic with weak local anesthetic properties

A

Meperidine

93
Q

Chorioamnionitis increases fetus’ risk of?

A

Cerebral palsy

94
Q

Risk of benzodiazepine use in pregnancy

A

Cleft palate

95
Q

Normal CMRO2

A

3.5 mL/100 g/min

96
Q

Normal cerebral blood flow

A

50 mL/100 g/min

97
Q

How many times a day does entire CSF volume replace itself?

A

About 3 times a day. Avg adult CSF volume: 150cc.

98
Q

Volume of venous air embolism that is fatal

A

300 cc

99
Q

Hunt and Hess scale

A

0-5 for classifying severity of SAH

0: unruptured
1: mild
2: mod-severe
3: drowsy, confused
4: stupor, hemiparesis
5: comatose

100
Q

Greatest risk over one week after ruptured cerebral aneurysm

A

Cerebral vasospasm (incidence is around 15%)

101
Q

Triple H therapy for cerebral vasospasm prevention and treatment

A

Hypertension, hypervolemia, and hemodilution

102
Q

Anti seizure medication should be continued for how long after a traumatic brain injury

A

7 days

103
Q

How is neuraxial anesthesia controversial for patients with multiple sclerosis?

A

Small case studies show increased rate of MS flare ups compared to GA

104
Q

Hot or cold temperatures exacerbates multiple sclerosis?

A

Hyperthermia

105
Q

Why is succinylcholine relatively contraindicated for multiple sclerosis patients?

A

Since MS is an upper motor neuron demyelinating disease, patients are prone to hyperkalemia, especially in setting of paresis and paralysis

106
Q

Myasthenia gravis patient’s response to succinylcholine being given

A

Resistance to succinylcholine because of lack of acetylcholine receptors, and then more sensitive to non depolarizers

107
Q

Why is neuraxial anesthesia considered contraindicated for Guillian-Barre syndrome patients?

A

Weak evidence shows increased risk of GBS exacerbation

108
Q

3 things to avoid in a myotonic dystrophy patient with contracture

A

Succinylcholine, neostigmine, and hypothermia

109
Q

Risk factors for postop mechanical ventilation in myasthenia gravis patients

A

Pyridostigmine > 750 mg/day, vital capacity < 2.9L, disease duration > 6 yrs

110
Q

What are the effects of succinylcholine and non depolarizers in patients with Eaton Lambert syndrome?

A

Both are more sensitive in ELS patients

111
Q

Greatest cause of perioperative morbidity in Duchenne’s muscular dystrophy patients

A

Respiratory complications secondary to restrictive pulmonary disease and pulmonary hypertension

112
Q

How does lithium affect muscle relaxants?

A

Lithium potentiates both depolarizing and nondepolarizing agents

113
Q

Drug that is most commonly abused among anesthesiologist and most likely associated with relapse

A

Fentanyl

114
Q

Normal vitals for preterm

A

HR 160
SBP 50
DBP 30
RR 50

115
Q

Normal vitals for term newborn

A

HR 130
SBP 60
DBP 40
RR 50

116
Q

Normal vitals for 1 yr old

A

HR 120
SBP 80
DBP 60
RR 25

117
Q

Normal vitals for toddler

A

HR 90
SBP 100
DBP 60
RR 20

118
Q

Eaton lambert syndrome and myasthenia gravis sensitivity to nondepolarizers is increased or decreased

A

Increased.

119
Q

How does up regulation of extrajunctional acetylcholine receptors affect response to muscle relaxants

A

Resistance to nondepolarizers and more sensitivity to depolarizers

120
Q

How does autoimmune disorders affect response to muscle relaxants

A

Increased sensitivity to both nondepolarizers and depolarizers

121
Q

Metabolism of mevacurium

A

Pseudocholinesterase

122
Q

Why doesn’t glycopyrrolate cause mydriasis?

A

It’s quaternary structure prevents it from cross blood brain barrier so CNS and pupillary effects are not seen

123
Q

Treatment for central anticholinergic syndrome

A

Physostigmine (tertiary structure allows it to cross blood brain barrier to “reverse” effects of scopolamine

124
Q

Systolic pressure is higher at aorta or radial artery?

A

Radial artery

125
Q

What is ecothiophate and what anesthetic drug should be avoided?

A

Irreversible cholinesterase inhibitor used for chronic glaucoma. Avoid using succinylcholine and other drugs metabolized by plasma cholinesterases including pseudocholinesterase.

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