Medicine and Anesthesia Flashcards
What is the most common fatal rhythm seen in myocardial infraction?
v fib
What is the cause of venoirritation & thrombophlebitis during injection of Diazapan?
Propylene glycol
What shifts oxy-hemoglobin saturation to right?
Increases in Temp, CO2, H+ ion (↓pH), 2-3 dpg – muscle at work, Hemoglobin has ↓O2 affinity therefore less saturated
Late finding in progression of Malignant Hyperthermia?
Late: ↑ Temperature
Early: early finding is tachycardia
Most Sensitive sign: is ↑ETCO2
Most common arrhythmia in hyperthyroidism?
Sinus tachycardia
What is the mechanism of action of Metformin?
Biguinides (Metformin, tradename Glucophage) decreases hyperglycemia primarily
by suppressing glucose production by the liver (hepatic gluconeogenesis).
What is the mechanism of action of Glipizide?
Sulfonylureas (most commonly, Glipizide, Glyburide) increase insulin production from beta cells in pancreas
What muscle relaxant should not be used in a patient with renal failure?
Pancuronium and doxacurium
Most of the nondepolarizing agents are metabolized by the liver and excreted by the kidney. Three of these are less dependent on hepatic or renal function. Mivacurium, like SCh, is metabolized by pseudocholinesterase and is affected by its deficiency. Atracurium and cisatracurium are removed by Hofmann elimination, whereby the drug spontaneously degrades at body pH and temperature.
What inhalational agent should be avoided in renal patients?
Avoid Sevoflurane in renal patients: carbon dioxide abosrbents react with sevoflurane to form vinyl ether (compound A) which is nephrotoxic
Preoperative dosing of ASA leads to increased incidence of what?
asthma attack
Decreased pulmonary changes in pregnant patient
FRC, RV, ERV
Increased pulmonary changes in pregnant patient
TV, inspiratory capacity, MV, oxygen consumption
Unchanged pulmonary changes in pregnant patient
FVC, FEV-1
The wedge pressure of a pulmonary catheter is used to measure?
Left ventricular end diastolic pressure (LVEDP)
The delay in conduction at the AV node is due to:
Sodium and calcium channels
What lab test would be elevated in malignant hyperthermia?
CPK, K (potassium), myoglobin
Ketamine is contraindicated in which patients?
HTN
Hours after a procedure, the patient is still not breathing, what is the likely cause?
Atypical pseudocholinesterase deficiency
In who is nitrous oxide contraindicated?
Repeat otitis media, sinus infection, GI obstruction, Closed Head Injury
How would you give an intraoral V2 block?
Through greater palatine canal, up to foramina rotundum
Develop a facial nerve palsy s/p IAN block?
Injection too far posterior and lateral
PDA murmur
harsh systolic & diastolic murmur
COPD vs RLD vs muscular weakness pulmonary
COPD: decreased FEV1 and FEV1/FVC ratio and increased RV, FRC
RLD: decreased TLC,FVC, RV, FRC with a normal FEV1
MW: similar to restrictive only DIFFERENCE IS FEV1 is reduced and RV is high, FRC is normal
What is the effect of aortic stenosis on MAP?
decreases
What causes clotting of exudates?
calcium
How many Kcal are in 2400cc of D5LR?
480
5% means 0.05 so 5 per 100cc
In a patient with MI, what enzyme is elevated?
CK-MB, troponin
LDH is late
Which inhalation agent should not be used on children?
desflurane
What makes a local anesthetic more potent?
lipid solubility
What makes a local anesthetic have a longer duration?
protein binding
What makes a local anesthetic have a faster onset?
pKA
How does aortic stenosis alter blood pressure?
Diastolic pressure ↑, MAP ↓
Injection of local into nerve which causes numbness, where is the damage?
Fascicular from ballooning
Which disease would you expect to see an increase in uric acid?
Renal failure, Gout
You place an IV catheter into the antecubital fossa and return arterial blood, what artery is involved?
brachial
Which is the most potent vasoconstrictor?
Norepinephrine>epinephrine>phenylephrine
A patient with pulmonary disease is given a bronchodilator and has improvement in FEV1, what type of disease does he have?
Reversible obstructive (asthma)
What type of coagulopathy does a patient with an elevated PTT & an elevated bleeding time most likely have?
VW
What type of coagulopathy does a patient with an elevated PTT most likely have?
hemophilia
What type of coagulopathy does a patient with an elevated PTT & PT most likely have?
warfarin
Why is midazolam the quickest acting benzodiazepine?
lipid solubility
A pulse oximeter reading of 90% corresponds to a pO2 of?
60mm hg
What muscle relaxant would you give to a patient in renal failure?
Atracurium, cisatracurium are removed by Hofmann elimination whereby the drug spontaneously degrades at body pH and temperature. Mivacurium is eliminated by
pseudocholinesterase
What is the effect of a loose BP cuff on the reading?
too low
Why give supplemental steroids to an adrenally suppressed patient in the perioperative period?
To prevent adrenal crisis (hypotension & hypoglycemia)
How does epinephrine increase the heart rate?
stimulates beta 1
How does heparin work?
Inactivates Xa and potentates antithrombin III
Which local anesthetic causes methemaglobinemia?
Prilocaine (as well as benzocaine and articaine and antiniotics such as trimethoprim, sulfanomides, and dapsone and Bactrim)
How does dantrolene work?
Inhibits Calcium release from sarcoplasmic reticulum
What are some clinical findings of adrenal insufficiency?
Hypotension, Hyponatremia, Hypoglycema, tachycardia, hyperkalemia, hypercalcemia, metabolic acidosis, azotemia (high nitrogen levels)
Para-aminobenzoic acid allergy which one not to give?
benzocaine
Definition of moderate sedation
Respond purposefully to verbal command
Dantrolene dose
10 mg/kg
MAC for Nitrous
105
Max epi for coronary artery disease
0.04 mg (2 carpules 2% lidocaine 1:100,000epi) 0.2mg non cardiac patient
What correlates with infection and length of hospital stay?
albumin
What is true about running GA with remi/propofol vs sevo?
Decreased post-op pain
When you stop propofol, why does someone wake up so quick
Because of rapid peripheral distribution
Myasthenia gravis – pt desatting and you bag mask and take to hospital, what do you start?
Plasmaphoresis
Which medicine causes increase HTN and makes HTN meds not effective
ibuprofen
What worsens APAP toxicity?
dilantin/phenytoin
What is multiple sclerosis?
Neurodegenerative demylenating degenerative of CNS
Dexmedetomidine (Precedex) MOA
alpha 2 agonist
Dexmedetomidine (Precedex) effects
Anxiolytic, Sedative, and Analgesic Amnesia is NOT an effect of this med
Bit by brown recluse and what do you give to prevent necrosing?
dapsone
Why do children become more sensitive to inhalational anesthetics (MAC is faster)?
They have relatively higher alveolar ventilation rate
Children have a lower FRC, alveolar surface area, and chest wall compliance but a higher alveolar ventilation rate
With chronic alcoholic cirrhosis and on Erythromycin and Methadone, what happens when you acutely stop erythromycin?
need to decrease methadone
Correct dose of lidocaine in micrograms/min/kg to treat ventricular fibrillation (did not say anything about bolus):
Initial dose: 1-1.5mg/kg IV
Maintenance dose is 1-4mg/min (30-50mcg/kg/min)
Young girl sedated for wisdom teeth extraction, given Ringers lactate. What happens to lactate?
Metabolized in liver
Lactate is metabolized in the liver into bicarbonate to counteract acidosis which is present in acute fluid loss but is not suitable for maintenance fluid due to low levels of sodium (130meq/L) and potassium (4meq/L)
Hypercalcemia EKG
hort QT interval suggest hypercalcaemia. Significant hypercalcaemia can cause ECG changes mimicking an acute myocardial infarction
ECG finding mimicking hypothermia, known as an Osborn wave.
Most likely complication of reversing diazepam with Romazicon
seizures
Romazicon dose
0.2mg q 1-2 min (up to 1mg max/5 min), 3mg max in 1 hr
Which antibiotics block protein synthesis?
The following antibiotics bind to the 30S subunit of the ribosome:
Aminoglycosides
Tetracyclines
The following antibiotics bind to the 50S ribosomal subunit: Chloramphenicol Erythromycin Clindamycin (lincosamide) Linezolid Macrolides (azithromycin)
Long term complication of hyphema
glaucoma
Tidal volume for child on ventilator
5-7 cc/kg for premature infants and 7-10 cc/kg for term infants.
Want antibiotic concentration to be what in relation to minimum inhibitory concentration?
The plasma concentration of the antibiotic in the blood should exceed the MIC by a
factor of 3-4 times to offset the tissue barriers that restrict access to the effected site
Change patient’s position during a general anesthetic and the BP drops. What is the name of the reflex that caused?
baroreceptor
Murmer that is continuous through systolic and diastolic
PDA
holosystolic murmur
mitral regurg
crescendo-decrescendo systolic murmur
AS
late diastolic murmur
MS
decrescendo diastolic murmur
AR
Signs of endocarditis
oslar’s nodes (raised red lesions on palms and soles) roths spot (retinal hemorrhage) janeway lesions (hemorrhagic nodules on palms and soles)
Best screening for cardiac contusion
EKG
What crosses blood-brain barrier the best?
Small Liphophilic, non-ionized molecules
Differences in pediatric airway
- tongue is larger
- pharynx in smaller
- epiglottis is larger and floppier
- larynx is more ant and sup
- cricoid is narrowest
- trachea is more cephaled
Best judgement/indicator of fluid overload early
weight
Which hypertension med is will alter hemodynamics with local/epi?
labetalol
Which Ekg lead is the best to see P wave propogation?
lead II
How do you treat SEVERE vWF periop?
FFP, cryoprecipitate (20 bag), ddavp
Plavix (Clopidogrel) mechanism of action
Inhibitor of ADP on platelet
In an asthmatic patient what percent increase in FEV that indicates recovery?
12%/200mL after inhaler
What med would a patient have increased sensitivity to with Myasthenia Gravis?
myasthenia gravis patients have resistance to succinylcholine (depolarizing muscle relaxant) and increased sensitivity to non-depolarizing muscle relaxants (ie, vecuronium)
Bulemics show what labs?
Metabolic Alkolosis, Hypokalemia, Hyponatremia, Hypochoremia, Hyperphostphatemia
Treatment for tachycardia with meds as well as vagal maneuvers
narrow QRS and monomorphic regular: vagal maneuvers, adenosine 6mg rapid iv push (followe by 12mg if needed), consider b-blockers and calcium channel blockers and expert consultation
How exactly does epinephrine increase heart rate. Exactly where is it acting.
Beta 1 receptors of sa node in the right atrium
Main clinical difference between psoriatic arthritis and RA
RA is bilateral
Why give K in treatment of DKA?
A patient in DKA has been peeing out all of their potassium stores and are overall very potassium depleted, despite having normal or high serum potassium levels to begin with. In addition to being potassium depleted, the insulin you are giving will cause a shift of potassium from the extracellular space to the intracellular space, which will drop the serum potassium. Thus, we give DKA patients potassium in addition to the insulin before they become hypokalemic.
CPR is done with ETT in place with ETCO2 waveform of 7
Chest compressions inadequate
Elavil (amitriptyline) is given for TMJ patients due to what properties?
An inhibitory action of amitriptyline on nAChRs in unmyelinated nociceptive axons may be an important component of amitriptyline’s therapeutic effect in the treatment of neuropathic pain. Low concentrations of amitriptyline inhibit nicotinic receptors in unmyelinated axons of human peripheral nerve
Know glucose levels of CSF in relation to serum AND nasal
Blood > CSF > nasal
normal glucose values: serum (80-120mg/100mL)
CSF (58-90/100ml)
nasal secretions (14-32/100ml)
Redman’s Syndrome
Vanco infusion with chest pain, hypotension, rash
non-specific mast cell degranulation and are not an IgE-mediated allergic reaction
When you do use LMA?
when mask ventilation is difficult
Indication for verapamil:
vasospastic angina
Verapamil is slow calcium channel blocker used in the treatment of htn, angina, arrhtyhmias, cluster and migraine headaches.
Contraindication for oral verapamil?
Sick sinus syndrome
severe left ventricular dysfunction, hypotension, sick sinus syndrome, second or third degree av block, a flutter, a fib
horners syndrome
miosis (a constricted pupil)
ptosis (a weak, droopy eyelid)
apparent anhidrosis (decreased sweating)
with or without enophthalmus (inset eyeball).
Where is ADH made?
posterior pituitary
ADH MOA
Increase water absorption in the collecting ducts of the kidney nephron
What is associated with Cat bite?
Aerobic Gram negative rod (bacillus) bacteria (Bartonella henselae)
Consequence of mitral valve stenosis
atrial fibrillation, pulmonary edema, mitral regurgitation, hepatosplenomegaly
MG pathophysiology
antibody to postsynaptic NM receptor
MG treatment:
acetylcholine esterase inhibitors (pyridostigmine) or immunosuppressants (prednisone)
propofol effects
neuroprotective when given right after strokes
and has a negative inotropic
Zofran: mechanism of action?
serotonin 5-HT3 receptor antagonist
Malignant Hyperthermia enzyme
creatine kinase (CK), aka CPK
Each unit of packed cells (with 300 ml) contains ~200 ml of RBCs increases Hgb by?
Increase Hct by ~3-4%
Increase Hgb by ~1 g/dL
cocaine-induced hypertension, use what?
Ca channel blocker (diltiazem), NG, BZD
blurry vision when patient lies down but gradually clears spontaneously when the pt stands
up
hyphema: loss of field vision
Cause of bleeding in leukemia patient?
megakaryocyte dysfunction (PLT)
Cause of PEA
cardiac tamponade
mouth and skin lesions and perihilar lymph nodes
sarcoid
Parkinson patient, what meds to avoid?
Antidopaminergic: droperidol, metoclopramide (reglan), prochlorperazine (Compazine) (may cause extrapyramidal effects)
Treatment of SIADH:
fluid restriction initially
Eye findings in HTN
- av nicking
- copper wire arterioles and cotton wool spots
- optic disc edema.
What factor in the coagulation cascade activates complement, clotting and kinin:
factor 12a (Hageman factor)
Sevo vs halothane with kid choices:
lower MAC w/ halothane
