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Board Review > Medicine and Anesthesia > Flashcards

Medicine and Anesthesia Flashcards

1
Q

What is the most common fatal rhythm seen in myocardial infraction?

A

v fib

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2
Q

What is the cause of venoirritation & thrombophlebitis during injection of Diazapan?

A

Propylene glycol

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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

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4
Q

Late finding in progression of Malignant Hyperthermia?

A

Late: ↑ Temperature
Early: early finding is tachycardia
Most Sensitive sign: is ↑ETCO2

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5
Q

Most common arrhythmia in hyperthyroidism?

A

Sinus tachycardia

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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).

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7
Q

What is the mechanism of action of Glipizide?

A

Sulfonylureas (most commonly, Glipizide, Glyburide) increase insulin production from beta cells in pancreas

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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.

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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

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10
Q

Preoperative dosing of ASA leads to increased incidence of what?

A

asthma attack

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11
Q

Decreased pulmonary changes in pregnant patient

A

FRC, RV, ERV

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12
Q

Increased pulmonary changes in pregnant patient

A

TV, inspiratory capacity, MV, oxygen consumption

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13
Q

Unchanged pulmonary changes in pregnant patient

A

FVC, FEV-1

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14
Q

The wedge pressure of a pulmonary catheter is used to measure?

A

Left ventricular end diastolic pressure (LVEDP)

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15
Q

The delay in conduction at the AV node is due to:

A

Sodium and calcium channels

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16
Q

What lab test would be elevated in malignant hyperthermia?

A

CPK, K (potassium), myoglobin

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17
Q

Ketamine is contraindicated in which patients?

A

HTN

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18
Q

Hours after a procedure, the patient is still not breathing, what is the likely cause?

A

Atypical pseudocholinesterase deficiency

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19
Q

In who is nitrous oxide contraindicated?

A

Repeat otitis media, sinus infection, GI obstruction, Closed Head Injury

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20
Q

How would you give an intraoral V2 block?

A

Through greater palatine canal, up to foramina rotundum

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21
Q

Develop a facial nerve palsy s/p IAN block?

A

Injection too far posterior and lateral

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22
Q

PDA murmur

A

harsh systolic & diastolic murmur

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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

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24
Q

What is the effect of aortic stenosis on MAP?

A

decreases

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25
Q

What causes clotting of exudates?

A

calcium

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26
Q

How many Kcal are in 2400cc of D5LR?

A

480

5% means 0.05 so 5 per 100cc

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27
Q

In a patient with MI, what enzyme is elevated?

A

CK-MB, troponin

LDH is late

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28
Q

Which inhalation agent should not be used on children?

A

desflurane

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29
Q

What makes a local anesthetic more potent?

A

lipid solubility

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30
Q

What makes a local anesthetic have a longer duration?

A

protein binding

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31
Q

What makes a local anesthetic have a faster onset?

A

pKA

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32
Q

How does aortic stenosis alter blood pressure?

A

Diastolic pressure ↑, MAP ↓

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33
Q

Injection of local into nerve which causes numbness, where is the damage?

A

Fascicular from ballooning

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34
Q

Which disease would you expect to see an increase in uric acid?

A

Renal failure, Gout

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35
Q

You place an IV catheter into the antecubital fossa and return arterial blood, what artery is involved?

A

brachial

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36
Q

Which is the most potent vasoconstrictor?

A

Norepinephrine>epinephrine>phenylephrine

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37
Q

A patient with pulmonary disease is given a bronchodilator and has improvement in FEV1, what type of disease does he have?

A

Reversible obstructive (asthma)

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38
Q

What type of coagulopathy does a patient with an elevated PTT & an elevated bleeding time most likely have?

A

VW

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39
Q

What type of coagulopathy does a patient with an elevated PTT most likely have?

A

hemophilia

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40
Q

What type of coagulopathy does a patient with an elevated PTT & PT most likely have?

A

warfarin

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41
Q

Why is midazolam the quickest acting benzodiazepine?

A

lipid solubility

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42
Q

A pulse oximeter reading of 90% corresponds to a pO2 of?

A

60mm hg

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43
Q

What muscle relaxant would you give to a patient in renal failure?

A

Atracurium, cisatracurium are removed by Hofmann elimination whereby the drug spontaneously degrades at body pH and temperature. Mivacurium is eliminated by
pseudocholinesterase

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44
Q

What is the effect of a loose BP cuff on the reading?

A

too low

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45
Q

Why give supplemental steroids to an adrenally suppressed patient in the perioperative period?

A

To prevent adrenal crisis (hypotension & hypoglycemia)

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46
Q

How does epinephrine increase the heart rate?

A

stimulates beta 1

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47
Q

How does heparin work?

A

Inactivates Xa and potentates antithrombin III

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48
Q

Which local anesthetic causes methemaglobinemia?

A

Prilocaine (as well as benzocaine and articaine and antiniotics such as trimethoprim, sulfanomides, and dapsone and Bactrim)

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49
Q

How does dantrolene work?

A

Inhibits Calcium release from sarcoplasmic reticulum

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50
Q

What are some clinical findings of adrenal insufficiency?

A

Hypotension, Hyponatremia, Hypoglycema, tachycardia, hyperkalemia, hypercalcemia, metabolic acidosis, azotemia (high nitrogen levels)

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51
Q

Para-aminobenzoic acid allergy which one not to give?

A

benzocaine

52
Q

Definition of moderate sedation

A

Respond purposefully to verbal command

53
Q

Dantrolene dose

A

10 mg/kg

54
Q

MAC for Nitrous

A

105

55
Q

Max epi for coronary artery disease

A

0.04 mg (2 carpules 2% lidocaine 1:100,000epi) 0.2mg non cardiac patient

56
Q

What correlates with infection and length of hospital stay?

A

albumin

57
Q

What is true about running GA with remi/propofol vs sevo?

A

Decreased post-op pain

58
Q

When you stop propofol, why does someone wake up so quick

A

Because of rapid peripheral distribution

59
Q

Myasthenia gravis – pt desatting and you bag mask and take to hospital, what do you start?

A

Plasmaphoresis

60
Q

Which medicine causes increase HTN and makes HTN meds not effective

A

ibuprofen

61
Q

What worsens APAP toxicity?

A

dilantin/phenytoin

62
Q

What is multiple sclerosis?

A

Neurodegenerative demylenating degenerative of CNS

63
Q

Dexmedetomidine (Precedex) MOA

A

alpha 2 agonist

64
Q

Dexmedetomidine (Precedex) effects

A

Anxiolytic, Sedative, and Analgesic Amnesia is NOT an effect of this med

65
Q

Bit by brown recluse and what do you give to prevent necrosing?

A

dapsone

66
Q

Why do children become more sensitive to inhalational anesthetics (MAC is faster)?

A

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
Q

With chronic alcoholic cirrhosis and on Erythromycin and Methadone, what happens when you acutely stop erythromycin?

A

need to decrease methadone

68
Q

Correct dose of lidocaine in micrograms/min/kg to treat ventricular fibrillation (did not say anything about bolus):

A

Initial dose: 1-1.5mg/kg IV

Maintenance dose is 1-4mg/min (30-50mcg/kg/min)

69
Q

Young girl sedated for wisdom teeth extraction, given Ringers lactate. What happens to lactate?

A

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
Q

Hypercalcemia EKG

A

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
Q

Most likely complication of reversing diazepam with Romazicon

A

seizures

72
Q

Romazicon dose

A

0.2mg q 1-2 min (up to 1mg max/5 min), 3mg max in 1 hr

73
Q

Which antibiotics block protein synthesis?

A

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
Q

Long term complication of hyphema

A

glaucoma

75
Q

Tidal volume for child on ventilator

A

5-7 cc/kg for premature infants and 7-10 cc/kg for term infants.

76
Q

Want antibiotic concentration to be what in relation to minimum inhibitory concentration?

A

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
Q

Change patient’s position during a general anesthetic and the BP drops. What is the name of the reflex that caused?

A

baroreceptor

78
Q

Murmer that is continuous through systolic and diastolic

A

PDA

79
Q

holosystolic murmur

A

mitral regurg

80
Q

crescendo-decrescendo systolic murmur

A

AS

81
Q

late diastolic murmur

A

MS

82
Q

decrescendo diastolic murmur

A

AR

83
Q

Signs of endocarditis

A 
oslar’s nodes (raised red lesions on palms and soles) roths spot (retinal hemorrhage) 
janeway lesions (hemorrhagic nodules on palms and soles)
84
Q

Best screening for cardiac contusion

A

EKG

85
Q

What crosses blood-brain barrier the best?

A

Small Liphophilic, non-ionized molecules

86
Q

Differences in pediatric airway

A
  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
Q

Best judgement/indicator of fluid overload early

A

weight

88
Q

Which hypertension med is will alter hemodynamics with local/epi?

A

labetalol

89
Q

Which Ekg lead is the best to see P wave propogation?

A

lead II

90
Q

How do you treat SEVERE vWF periop?

A

FFP, cryoprecipitate (20 bag), ddavp

91
Q

Plavix (Clopidogrel) mechanism of action

A

Inhibitor of ADP on platelet

92
Q

In an asthmatic patient what percent increase in FEV that indicates recovery?

A

12%/200mL after inhaler

93
Q

What med would a patient have increased sensitivity to with Myasthenia Gravis?

A

myasthenia gravis patients have resistance to succinylcholine (depolarizing muscle relaxant) and increased sensitivity to non-depolarizing muscle relaxants (ie, vecuronium)

94
Q

Bulemics show what labs?

A

Metabolic Alkolosis, Hypokalemia, Hyponatremia, Hypochoremia, Hyperphostphatemia

95
Q

Treatment for tachycardia with meds as well as vagal maneuvers

A

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
Q

How exactly does epinephrine increase heart rate. Exactly where is it acting.

A

Beta 1 receptors of sa node in the right atrium

97
Q

Main clinical difference between psoriatic arthritis and RA

A

RA is bilateral

98
Q

Why give K in treatment of DKA?

A

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
Q

CPR is done with ETT in place with ETCO2 waveform of 7

A

Chest compressions inadequate

100
Q

Elavil (amitriptyline) is given for TMJ patients due to what properties?

A

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
Q

Know glucose levels of CSF in relation to serum AND nasal

A

Blood > CSF > nasal
normal glucose values: serum (80-120mg/100mL)
CSF (58-90/100ml)
nasal secretions (14-32/100ml)

102
Q

Redman’s Syndrome

A

Vanco infusion with chest pain, hypotension, rash

non-specific mast cell degranulation and are not an IgE-mediated allergic reaction

103
Q

When you do use LMA?

A

when mask ventilation is difficult

104
Q

Indication for verapamil:

A

vasospastic angina

Verapamil is slow calcium channel blocker used in the treatment of htn, angina, arrhtyhmias, cluster and migraine headaches.

105
Q

Contraindication for oral verapamil?

A

Sick sinus syndrome

severe left ventricular dysfunction, hypotension, sick sinus syndrome, second or third degree av block, a flutter, a fib

106
Q

horners syndrome

A

miosis (a constricted pupil)
ptosis (a weak, droopy eyelid)
apparent anhidrosis (decreased sweating)
with or without enophthalmus (inset eyeball).

107
Q

Where is ADH made?

A

posterior pituitary

108
Q

ADH MOA

A

Increase water absorption in the collecting ducts of the kidney nephron

109
Q

What is associated with Cat bite?

A

Aerobic Gram negative rod (bacillus) bacteria (Bartonella henselae)

110
Q

Consequence of mitral valve stenosis

A

atrial fibrillation, pulmonary edema, mitral regurgitation, hepatosplenomegaly

111
Q

MG pathophysiology

A

antibody to postsynaptic NM receptor

112
Q

MG treatment:

A

acetylcholine esterase inhibitors (pyridostigmine) or immunosuppressants (prednisone)

113
Q

propofol effects

A

neuroprotective when given right after strokes

and has a negative inotropic

114
Q

Zofran: mechanism of action?

A

serotonin 5-HT3 receptor antagonist

115
Q

Malignant Hyperthermia enzyme

A

creatine kinase (CK), aka CPK

116
Q

Each unit of packed cells (with 300 ml) contains ~200 ml of RBCs increases Hgb by?

A

Increase Hct by ~3-4%

Increase Hgb by ~1 g/dL

117
Q

cocaine-induced hypertension, use what?

A

Ca channel blocker (diltiazem), NG, BZD

118
Q

blurry vision when patient lies down but gradually clears spontaneously when the pt stands
up

A

hyphema: loss of field vision

119
Q

Cause of bleeding in leukemia patient?

A

megakaryocyte dysfunction (PLT)

120
Q

Cause of PEA

A

cardiac tamponade

121
Q

mouth and skin lesions and perihilar lymph nodes

A

sarcoid

122
Q

Parkinson patient, what meds to avoid?

A

Antidopaminergic: droperidol, metoclopramide (reglan), prochlorperazine (Compazine) (may cause extrapyramidal effects)

123
Q

Treatment of SIADH:

A

fluid restriction initially

124
Q

Eye findings in HTN

A
  1. av nicking
  2. copper wire arterioles and cotton wool spots
  3. optic disc edema.
125
Q

What factor in the coagulation cascade activates complement, clotting and kinin:

A

factor 12a (Hageman factor)

126
Q

Sevo vs halothane with kid choices:

A

lower MAC w/ halothane

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