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Comprehensive Exam #1 Study Guide > Main points from brain dump > Flashcards

Main points from brain dump Flashcards

1
Q

A deficiency of what causes angioedema?

A

C-1 esterase inhibitor

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2
Q

What are 2 treatment options for angioedema?

A

C1 inhibitor concentrate or FFP

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3
Q

What are the 3 goals of treatment for anaphylaxis?

A
  1. reverse hypotension
  2. reverse hypoxemia
  3. inhibit cell degranulation
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4
Q

What causes anaphylaxis?

A

mass release of vasoactive mediators via degranulation of mast cells and basophils - the antigen reacts with IgE

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5
Q

_____ and ____ undergo degranulation during anaphylaxis

A

mast cells and basophils

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6
Q

______ is not associated with an IgE reaction.

A

Anaphylactoid

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7
Q

What is lost after heart transplant?

A

Vagal tone

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8
Q

There are no ___,___,or___ innervation after heart transplant.

A

sympathetic, parasympathetic, or sensory

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9
Q

After heart transplant, the patient is ____ dependent.

A

preload

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10
Q

What drugs do not work after heart transplant?

A

Ephedrine and Atropine

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11
Q

How long is a kidney viable for transplantation?

A

48 hours

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12
Q

After kidney transplant, the SBP should be ____ and volume status should be ______ to maintain urine output.

A

high-normal SBP; euvolemia

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13
Q

Can a newly transplanted kidney clear NMBD and anticholinesterase?

A

yes

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14
Q

What is given to faciliate urine formation by new kidney after transplant?

A

Mannitol

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15
Q

What happens after unclamping during kidney transplnat?

A

hypotension

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16
Q

What is the treatment for acute rejection of kidney?

A

removal

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17
Q

What are the LFT after liver tranplant?

A

normal

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18
Q

What are respiratory considerations wtih liver transplant?

A

oxygenation improves, but intrapulmonary shunt may persist

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19
Q

What is the most common indication for liver transplant?

A

cirrhosis d/t HCV

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20
Q

Post-op liver transplant, the normal physiologic mechanism that protect hepatic blood flow are ____

A

blunted

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21
Q

Post-op liver transplant, autotransfusion of blood voluem in shock via a vasoconstrictive response is _____

A

impaired

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22
Q

What hormones are released with small cell lung cancer?

A

ADH, ACTH, PTH

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23
Q

With shock, resuscitation is targeted to achieve a MAP >____

A

65

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24
Q

With shock, resuscitation is targeted to achieve a CVP __-___

A

8-12

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25
Q

With shock, resuscitation is targeted to achieve a ____ UO

A

adequate

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26
Q

With shock, resuscitation is targeted to achieve a ____ pH

A

normal

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27
Q

With shock, resuscitation is targeted to achieve a mixed venous oxygen saturation >____

A

70%

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28
Q

How long does processing of harvested bone marrow take?

A

2-12 hours

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29
Q

How long does bone marrow engraftment take?

A

10-28 days

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30
Q

When are MG exacerbations most likely to occur during pregnancy?

A

1st trimester and early postpartum

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31
Q

Type ____ MG is limited to extraocular muscles

A

1

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32
Q

What is MG?

A

An autoimmune disorder that causes decrease in functional Ach receptors at NMJ d/t destruction by antibodies

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33
Q

MG has a related occur to _____ problems

A

thymus gland

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34
Q

What is 1st line treatment for MG?

A

Anticholinesterase (Pyridostigmine)

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35
Q

What medications exacerbate MG?

A

Penicillamine
ND NMBD
AMinoglycosides
Procainamide

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36
Q

What population is MG most common in?

A

Women 20-30

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37
Q

Can you give ND NMBD with MG?

A

yes, if you need to, you should decrease dose by 1/2-1/3

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38
Q

What response might be absent with GB?

A

compensatory CV response

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39
Q

When can profound hypotension occur with GB?

A

positioning, blood loss, PPV

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40
Q

Can you administer sux with GB?

A

No

41
Q

Why can you not administer sux with GB?

A

risk for excessive K+ release

42
Q

What should ventilation be initiated in patients wtih GB?

A

VC <15 mL /kg

43
Q

What NMB can be used with GB?

A

Vec or Nimbex - no histmaine release and minimal circulatory effects

44
Q

Where does weakness start with GB?

A

in legs and spreads cephalad

45
Q

What happens to postsynaptic receptors in GB? What does this cause?

A

upregulation of receptors; exaggerated response to indirect-acting vasopressors

46
Q

Myasthentic syndrome is also called what?

A

Eaton-Lambert

47
Q

What is eaton-lambert?

A

a disorder of NM transmission that resembles MG; IgG antibodies to voltage-sensitive Ca+ channels causes defiiences in these channels

48
Q

In eaton-lambert, ___ antibodies to voltage-sensitive ___ channels cuase deficiency fo these channels.

A

IgG; Ca+

49
Q

Will you see an improvement of S/S of Eaton-Lambert with anticholinesterase?

A

No

50
Q

Will you see an improvement of MG with anticholinesterase?

A

Yes

51
Q

How do you treat eaton-lambert?

A

IVIG, Plasmapheresis, cancer treatment

52
Q

What patient population is eaton-lambert more common in?

A

Males

53
Q

Are patients with eaton lambert sensitive to Sux? What about other ND NMBD?

A

Yes; and yes

54
Q

Eaton-Lambert/Myasthenic syndrome has a relationship to what other problem?

A

SCC of lung

55
Q

What is another name for anti-glomerular basement membrane antibody disease?

A

Goodpasture syndrome

56
Q

What 2 things are associated with goodpasture syndrome?

A

glomerulonephritis and pulmonary hemorrhage

57
Q

GOodpasture is most common in waht patient population?

A

young males

58
Q

Why is plasmapheresis used in goodpasture?

A

to remove disease-causing antibodies

59
Q

What are the 2 treatments used in goodpasture?

A

plasmaphereiss and corticosteroids

60
Q

What is the prognosis of goodpasture?

A

poor

61
Q

How soon does renal failure develop in patients with goodpasture?

A

1 year

62
Q

In pts with goodpasture, pulmonary dx occurs in ___%

A

50-60%

63
Q

For patients iwth COPD, post-op ventilation may be needed if the FEV1/FVC ratio is ____ or pre-op PaCO2 ____-

A

<50%; >50

64
Q

COPD patients have:
____ RV
___ FRC
___TLC

A

increased RV, FRC, and TLC

65
Q

What deficiency is associated with COPD?

A

alpha1-antitrypsin

66
Q

What is the diagnosis for COPD?

A

FEV1/FVC <70% not reversible with bronchodilators

67
Q

When is O2 recommended for COPD patients?

A

PaO2 <55
Hct >55
Cor pulmonale

68
Q

What is a predictor of post-op complciations in COPD patients?

A

Poor nutritional status w/ albumin <3.5

69
Q

What happens in Aperts?

A

Cranium, midface, bones, soft tissue of hands and feet all fuse

70
Q

What are anesthetic considerations with Aperts?

A

Possible difficult airway/airway obstruction, OSA, difficult IV access

71
Q

What is Crouzons?

A

Fusion of cranium, midface bones
(DOES NOT INCLUDE VISCERA AND EXTREMITIES LIKE APERTS)

72
Q

How do you treat porphyria crisis?

A

hydration and carbs

73
Q

What meds should NOT be given to porphyria?

A

Etomidate, barbiturates, toradol

74
Q

In porphyria, single exposure to potent triggers may be well-tolerated, ______ acute attack

A

not during

75
Q

What porphyria condition is life-threatening?

A

acute intermittent porphyria

76
Q

What is the induction drug of choice in patients with porphyria?

A

propofol

77
Q

How do you treat acute attcks of porphyria?

A

heme therapy

78
Q

What is charcot-marie-tooth?

A

inherited disorder that leads to alterations in peripheral nerve function

79
Q

The peripheral nerve dysfunction associated with charcot-marie-tooth is limited to ____

A

lower 1/3 of legs

80
Q

What deformities occur with charcot-marie-tooth?

A

foot deformities and peroneal muscle atrophy

81
Q

What are the anesthesia considerations for charcot-marie-tooth?

A

focus on respnse to NMB and possible post-op respiratory fialure

82
Q

What 3 things are done to manage pheochromocytoma?

A
  1. volume loading
  2. phenoxybenzamine
  3. DNP
83
Q

Where does pheochromocytoma arise from?

A

chromaffin cells

84
Q

Does clonidine have an effect in pheochromocytomae?

A

no

85
Q

When should you d/c phenoxybenzamine before pheochromocytoma revmoal?

A

24-48 horus prior to surgery (to avoid vascular unresponsiveness after tumor removal)

86
Q

With pheochromocytoma, never give ____ before _____ b/c it can lead to unopposed alpha agonism/HTN.

A

BB; alpha locker

87
Q

What is the agent of choice for HTN in pheochromocytoma?

A

SNP

88
Q

WHat is the most common nerve damaged with coarctation of aorta?

A

left laryngeal nerve

89
Q

What problems are associated with aortic clamping?

A

renal failure, gut ischemia, paraplegia

90
Q

where should you monitor BP for coarctation of aorta?

A

right arm (above clamp)

91
Q

What is the medical management for aortic aneurysms?

A

Statins, BB, avoid exercise

92
Q

What 3 conditions are commonly associated wtih aortic aneyrsym

A

ischemic heart dx, DM, renal dx

93
Q

DeBakey Class I:

A

proximal ascending aort, aortic arch, descending thoracic and abomdinal aorta

94
Q

Debakey class II:

A

ascending aorta only

95
Q

Debakey class III

A

descending or extends into abdominal or iliac arteries

96
Q

Surgery for AAA is recommended when AAA>___ or expands by >___/year

A

5.5cm or 0.6-0.6cm/yr

97
Q

What is the triad of S/S for ruptured AAA?

A

hypotension, back pain, pulsatile mass

98
Q

What is seen on X-ray wtih AAA?

A

wide mediastinum

99
Q

What heart chamber is most likley to be injured?

A

RV

Comprehensive Exam #1 Study Guide (3 decks)

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