Medicine and Anesthesia Flashcards
1
Q
What is the most common fatal rhythm seen in myocardial infraction?
A
v fib
2
Q
What is the cause of venoirritation & thrombophlebitis during injection of Diazapan?
A
Propylene glycol
3
Q
What shifts oxy-hemoglobin saturation to right?
A
Increases in Temp, CO2, H+ ion (↓pH), 2-3 dpg – muscle at work, Hemoglobin has ↓O2 affinity therefore less saturated
4
Q
Late finding in progression of Malignant Hyperthermia?
A
Late: ↑ Temperature
Early: early finding is tachycardia
Most Sensitive sign: is ↑ETCO2
5
Q
Most common arrhythmia in hyperthyroidism?
A
Sinus tachycardia
6
Q
What is the mechanism of action of Metformin?
A
Biguinides (Metformin, tradename Glucophage) decreases hyperglycemia primarily
by suppressing glucose production by the liver (hepatic gluconeogenesis).
7
Q
What is the mechanism of action of Glipizide?
A
Sulfonylureas (most commonly, Glipizide, Glyburide) increase insulin production from beta cells in pancreas
8
Q
What muscle relaxant should not be used in a patient with renal failure?
A
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.
9
Q
What inhalational agent should be avoided in renal patients?
A
Avoid Sevoflurane in renal patients: carbon dioxide abosrbents react with sevoflurane to form vinyl ether (compound A) which is nephrotoxic
10
Q
Preoperative dosing of ASA leads to increased incidence of what?
A
asthma attack
11
Q
Decreased pulmonary changes in pregnant patient
A
FRC, RV, ERV
12
Q
Increased pulmonary changes in pregnant patient
A
TV, inspiratory capacity, MV, oxygen consumption
13
Q
Unchanged pulmonary changes in pregnant patient
A
FVC, FEV-1
14
Q
The wedge pressure of a pulmonary catheter is used to measure?
A
Left ventricular end diastolic pressure (LVEDP)
15
Q
The delay in conduction at the AV node is due to:
A
Sodium and calcium channels
16
Q
What lab test would be elevated in malignant hyperthermia?
A
CPK, K (potassium), myoglobin
17
Q
Ketamine is contraindicated in which patients?
A
HTN
18
Q
Hours after a procedure, the patient is still not breathing, what is the likely cause?
A
Atypical pseudocholinesterase deficiency
19
Q
In who is nitrous oxide contraindicated?
A
Repeat otitis media, sinus infection, GI obstruction, Closed Head Injury
20
Q
How would you give an intraoral V2 block?
A
Through greater palatine canal, up to foramina rotundum
21
Q
Develop a facial nerve palsy s/p IAN block?
A
Injection too far posterior and lateral
22
Q
PDA murmur
A
harsh systolic & diastolic murmur
23
Q
COPD vs RLD vs muscular weakness pulmonary
A
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
24
Q
What is the effect of aortic stenosis on MAP?
A
decreases
25
What causes clotting of exudates?
calcium
26
How many Kcal are in 2400cc of D5LR?
480
| 5% means 0.05 so 5 per 100cc
27
In a patient with MI, what enzyme is elevated?
CK-MB, troponin
| LDH is late
28
Which inhalation agent should not be used on children?
desflurane
29
What makes a local anesthetic more potent?
lipid solubility
30
What makes a local anesthetic have a longer duration?
protein binding
31
What makes a local anesthetic have a faster onset?
pKA
32
How does aortic stenosis alter blood pressure?
Diastolic pressure ↑, MAP ↓
33
Injection of local into nerve which causes numbness, where is the damage?
Fascicular from ballooning
34
Which disease would you expect to see an increase in uric acid?
Renal failure, Gout
35
You place an IV catheter into the antecubital fossa and return arterial blood, what artery is involved?
brachial
36
Which is the most potent vasoconstrictor?
Norepinephrine>epinephrine>phenylephrine
37
A patient with pulmonary disease is given a bronchodilator and has improvement in FEV1, what type of disease does he have?
Reversible obstructive (asthma)
38
What type of coagulopathy does a patient with an elevated PTT & an elevated bleeding time most likely have?
VW
39
What type of coagulopathy does a patient with an elevated PTT most likely have?
hemophilia
40
What type of coagulopathy does a patient with an elevated PTT & PT most likely have?
warfarin
41
Why is midazolam the quickest acting benzodiazepine?
lipid solubility
42
A pulse oximeter reading of 90% corresponds to a pO2 of?
60mm hg
43
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
44
What is the effect of a loose BP cuff on the reading?
too low
45
Why give supplemental steroids to an adrenally suppressed patient in the perioperative period?
To prevent adrenal crisis (hypotension & hypoglycemia)
46
How does epinephrine increase the heart rate?
stimulates beta 1
47
How does heparin work?
Inactivates Xa and potentates antithrombin III
48
Which local anesthetic causes methemaglobinemia?
Prilocaine (as well as benzocaine and articaine and antiniotics such as trimethoprim, sulfanomides, and dapsone and Bactrim)
49
How does dantrolene work?
Inhibits Calcium release from sarcoplasmic reticulum
50
What are some clinical findings of adrenal insufficiency?
Hypotension, Hyponatremia, Hypoglycema, tachycardia, hyperkalemia, hypercalcemia, metabolic acidosis, azotemia (high nitrogen levels)
51
Para-aminobenzoic acid allergy which one not to give?
benzocaine
52
Definition of moderate sedation
Respond purposefully to verbal command
53
Dantrolene dose
10 mg/kg
54
MAC for Nitrous
105
55
Max epi for coronary artery disease
0.04 mg (2 carpules 2% lidocaine 1:100,000epi) 0.2mg non cardiac patient
56
What correlates with infection and length of hospital stay?
albumin
57
What is true about running GA with remi/propofol vs sevo?
Decreased post-op pain
58
When you stop propofol, why does someone wake up so quick
Because of rapid peripheral distribution
59
Myasthenia gravis – pt desatting and you bag mask and take to hospital, what do you start?
Plasmaphoresis
60
Which medicine causes increase HTN and makes HTN meds not effective
ibuprofen
61
What worsens APAP toxicity?
dilantin/phenytoin
62
What is multiple sclerosis?
Neurodegenerative demylenating degenerative of CNS
63
Dexmedetomidine (Precedex) MOA
alpha 2 agonist
64
Dexmedetomidine (Precedex) effects
Anxiolytic, Sedative, and Analgesic Amnesia is NOT an effect of this med
65
Bit by brown recluse and what do you give to prevent necrosing?
dapsone
66
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
67
With chronic alcoholic cirrhosis and on Erythromycin and Methadone, what happens when you acutely stop erythromycin?
need to decrease methadone
68
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)
69
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)
70
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.
71
Most likely complication of reversing diazepam with Romazicon
seizures
72
Romazicon dose
0.2mg q 1-2 min (up to 1mg max/5 min), 3mg max in 1 hr
73
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)
```
74
Long term complication of hyphema
glaucoma
75
Tidal volume for child on ventilator
5-7 cc/kg for premature infants and 7-10 cc/kg for term infants.
76
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
77
Change patient’s position during a general anesthetic and the BP drops. What is the name of the reflex that caused?
baroreceptor
78
Murmer that is continuous through systolic and diastolic
PDA
79
holosystolic murmur
mitral regurg
80
crescendo-decrescendo systolic murmur
AS
81
late diastolic murmur
MS
82
decrescendo diastolic murmur
AR
83
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)
```
84
Best screening for cardiac contusion
EKG
85
What crosses blood-brain barrier the best?
Small Liphophilic, non-ionized molecules
86
Differences in pediatric airway
1. tongue is larger
2. pharynx in smaller
3. epiglottis is larger and floppier
4. larynx is more ant and sup
5. cricoid is narrowest
6. trachea is more cephaled
87
Best judgement/indicator of fluid overload early
weight
88
Which hypertension med is will alter hemodynamics with local/epi?
labetalol
89
Which Ekg lead is the best to see P wave propogation?
lead II
90
How do you treat SEVERE vWF periop?
FFP, cryoprecipitate (20 bag), ddavp
91
Plavix (Clopidogrel) mechanism of action
Inhibitor of ADP on platelet
92
In an asthmatic patient what percent increase in FEV that indicates recovery?
12%/200mL after inhaler
93
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)
94
Bulemics show what labs?
Metabolic Alkolosis, Hypokalemia, Hyponatremia, Hypochoremia, Hyperphostphatemia
95
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
96
How exactly does epinephrine increase heart rate. Exactly where is it acting.
Beta 1 receptors of sa node in the right atrium
97
Main clinical difference between psoriatic arthritis and RA
RA is bilateral
98
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.
99
CPR is done with ETT in place with ETCO2 waveform of 7
Chest compressions inadequate
100
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
101
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)
102
Redman’s Syndrome
Vanco infusion with chest pain, hypotension, rash
non-specific mast cell degranulation and are not an IgE-mediated allergic reaction
103
When you do use LMA?
when mask ventilation is difficult
104
Indication for verapamil:
vasospastic angina
Verapamil is slow calcium channel blocker used in the treatment of htn, angina, arrhtyhmias, cluster and migraine headaches.
105
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
106
horners syndrome
miosis (a constricted pupil)
ptosis (a weak, droopy eyelid)
apparent anhidrosis (decreased sweating)
with or without enophthalmus (inset eyeball).
107
Where is ADH made?
posterior pituitary
108
ADH MOA
Increase water absorption in the collecting ducts of the kidney nephron
109
What is associated with Cat bite?
Aerobic Gram negative rod (bacillus) bacteria (Bartonella henselae)
110
Consequence of mitral valve stenosis
atrial fibrillation, pulmonary edema, mitral regurgitation, hepatosplenomegaly
111
MG pathophysiology
antibody to postsynaptic NM receptor
112
MG treatment:
acetylcholine esterase inhibitors (pyridostigmine) or immunosuppressants (prednisone)
113
propofol effects
neuroprotective when given right after strokes
| and has a negative inotropic
114
Zofran: mechanism of action?
serotonin 5-HT3 receptor antagonist
115
Malignant Hyperthermia enzyme
creatine kinase (CK), aka CPK
116
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
117
cocaine-induced hypertension, use what?
Ca channel blocker (diltiazem), NG, BZD
118
blurry vision when patient lies down but gradually clears spontaneously when the pt stands
up
hyphema: loss of field vision
119
Cause of bleeding in leukemia patient?
megakaryocyte dysfunction (PLT)
120
Cause of PEA
cardiac tamponade
121
mouth and skin lesions and perihilar lymph nodes
sarcoid
122
Parkinson patient, what meds to avoid?
Antidopaminergic: droperidol, metoclopramide (reglan), prochlorperazine (Compazine) (may cause extrapyramidal effects)
123
Treatment of SIADH:
fluid restriction initially
124
Eye findings in HTN
1. av nicking
2. copper wire arterioles and cotton wool spots
3. optic disc edema.
125
What factor in the coagulation cascade activates complement, clotting and kinin:
factor 12a (Hageman factor)
126
Sevo vs halothane with kid choices:
lower MAC w/ halothane
