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APEX-Miscellaneous > MISC-misc topics 12-23 > Flashcards

MISC-misc topics 12-23 Flashcards

1
Q

What are 3 causes of Creutzfeldt-Jakob disease

A
  1. consumption of contaminated animal protein
  2. contaminated implants (corneal or dural tissue)
  3. cadaveric pituitary hormone supplement
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2
Q

What is the most common source of bloodstream infection in hospitalized patients

A

central venous cath

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3
Q

What is the preferred method of skin prep for central line placement

A

chlorhexidine

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4
Q

What type of precautions are required for mycobacterium tuberculosis

A

airborne

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5
Q

How do positive TB findings appear on CXR

A

apical infiltrates and nodules

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6
Q

What is the first line treatment for TB

A

isoniazid

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7
Q

What are side effects of isoniazid

A

hepatotoxicity

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8
Q

What are side-effects of rifampin

A
  1. thrombocytopenia
  2. leukopenia
  3. anemia
  4. kidney failure
  5. orange color of urine, sweat, and tears
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9
Q

What procedure incurs the highest risk for transmission of TB

A

bronchoscopy

intubation is the second highest risk

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10
Q

How should the TB pt be cared for in the OR

A
  1. wear N95 for intubation
  2. HEPA filter in y-piece
  3. bacterial filter in expiratory limb
  4. dedicated anesthesia machine
  5. negative pressure isolation room
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11
Q

When can elective surgery in the TB pt proceed

A
  1. pt on anti-TB meds w/ 3 negative AFB tests

2. demonstrates symptom improvement

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12
Q

What defines a positive Mantoux test

A

Induration >10 mm at site of injection

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13
Q

How are WBCs divided

A
  1. Granulocytes (neutrophils, basophils, and eosinophils)

2. agranulocytes (monocytes, lymphocytes)

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14
Q

What are neurtophils

A

Immune defense, fighting bacteria and fungal infections

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15
Q

What type of cell makes up 60% of WBCs

A

neutrophils

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16
Q

What are basophils

A

Essential component of allergic reactions

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17
Q

What do 3 chemicals do basophils release

A
  1. histamine
  2. leukotrienes
  3. prostaglandins
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18
Q

How does epinephrine impact basophils

A

It prevents degranulation by binding to beta-2 receptors on cell membrane

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19
Q

What are eosinophils

A

they defend against parasites

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20
Q

What are monocytes

A

They fight bacterial, viral, and fungal infection via phagocytosis
Then present pieces of pathogens to T-lymphocytes

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21
Q

What chemical do monocytes release

A

cytokines

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22
Q

What are lymphocytes

A

cells that take part in immunity

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23
Q

What are 3 types of lymphocytes

A

B-lymphocytes
T-Lymphocytes
Natural killer cells

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24
Q

What are the following cells:
B-lymphocytes=
T-Lymphocytes=
Natural killer cells=

A

B-lymphocytes= humoral immunity producing antibodies
T-Lymphocytes= cell-mediated immunity
Natural killer cells= limits spread of tumor and microbial cells

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25
Q

What drug class reduces natural killer cells

A

opioids

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26
Q

Which type of lymphocyte produces anti-bodies

A

B-lymphocytes

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27
Q

Which lymphocyte is responsible for cell-mediated versus humoral immunity

A

humoral = B-lymphocyte

cell mediated = T-lymphocytes

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28
Q

What is the difference between anaphylaxis and anaphylactoid reaction

A 
anaphylaxis = requires prior sensitization or cross-reactivity
anaphylactoid = no prior exposure needed
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29
Q

What are 3 H1 receptor effects of hypersensitivity reactions

A
  1. vasodilation
  2. increased vascular permeability
  3. smooth muscle contraction
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30
Q

What are 2 H2 receptor effects of hypersensitivity reactions

A
  1. cardiac stimulation (tachy)

2. gastric acid secretion

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31
Q

What arachidonic acid metabolites participate in hypersensitivity reactions

A
  1. leukotrienes

2. prostaglandins

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32
Q

What are the effects of the following Leukotrienes

and Prostaglandins

A

bronchoconstriction and vasodilation

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33
Q

What are 4 CV effects of hypersensitivity reactions

A
  1. HoTN
  2. Tachycardia
  3. Arrhythmia
  4. cardiac arrest
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34
Q

What are 2 pulmonary effects of hypersensitivity reaction

A
  1. bronchospasm

2. laryngeal edema

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35
Q

What are 3 physiologic results of bronchospasm

A
  1. dec EtCO2
  2. dec SaO2
  3. inc PIP
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36
Q

What is the cause of laryngeal edema with hypersensitivity reactions

A

increased mucus production

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37
Q

What are 4 skin effects of hypersensitivity reactions

A
  1. flushing
  2. urticaria (hives)
  3. erythema
  4. pruritus
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38
Q

What are 3 GI effects of hypersensitivity reactions

A
  1. abdominal cramping
  2. N/V
  3. Diarrhea
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39
Q

How many types of hypersensitivity reactions exist

A

4

types 1-4

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40
Q

What are the 4 types of hypersensitivity reactions

A

Type 1= immediate hypersensitivity
Type 2= antibody-mediated
Type 3= immune complex mediated
Type 4= delayed

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41
Q

What is type 1 hypersensitivity reaction

A

Immediate hypersensitivity

Antigen + antibody interaction due to prior antigen sensitization

IgE mediated

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42
Q

Which hypersensitivity reaction is IgE mediated

A

Type 1

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43
Q

What lab test determines if an allergic response occurred

A

Tryptase b/c it is release from mast cells during an allergic reaction

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44
Q

What mediates a type 2 reaction

A

IgG and IgM antibodies

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45
Q

What is a type 2 reaction

A

anti-body mediated by IgG and IgM binding to cell surfaces

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46
Q

What does the type 2 reaction result in

A

activation of the complement cascade

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47
Q

What are 2 examples of a type 2 reaction

A
  1. ABO-incompatibility

2. HIT

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48
Q

What is a type 3 reaction

A

immune complex mediated

immune complex is formed and deposited into the patient’s tissue vs being cleared

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49
Q

What is the result of a type 3 reaction

A

activation of complement cascade

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50
Q

What is an example of type 3 reaction

A

snake venom reaction

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51
Q

What is a type 4 reaction

A

Allergic reaction delayed at least 12 hours following exposure

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52
Q

What are 3 examples of type 4 reactions

A
  1. contact dermatitis
  2. graft-v-host reaction
  3. tissue rejection
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53
Q

What pharmacologic treatment is used for intraoperative anaphylaxis

A
  1. epinephrine 5-10 mcg for HoTN or 0.1-1 mg for CV collapse
  2. H1-receptor antagonist (diphenhydramine)
  3. H2-receptor antagonist (ranitidine, famotidine)
  4. hydrocortisone
  5. albuterol
  6. vasopressin
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54
Q

What 3 ways does epinephrine treat anaphylaxis

A
  1. prevents degranulation
  2. provides CV support
  3. dilate airways
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55
Q

What supportive treatment is used for anaphylaxis (non-pharmacologic)

A
  1. discontinue offending agent
  2. Increase FiO2
  3. Provide airway support
  4. Liberal IV hydration
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56
Q

What is the most common cause of perioperative anaphylaxis

A

NMB drugs w/ succinylcholine as the most common

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57
Q

What are the top 3 causes of intraoperative anaphylaxis

A

NMB, latex, and abx

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58
Q

What are high risk groups for latex allergy

A
  1. spina bifida, myelomeningocele
  2. atopy
  3. health care worker
  4. allergy to banana, kiwi, mango, papaya, pineapple or tomato
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59
Q

Which chemotherapeutic drug does not suppress bone marrow or cause thrombocytopenia

A

bleomycin

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60
Q 
Name the most pertinent side-effect for anesthesia and the following chemotherapeutic agents:
Cisplatin= 
Vincristine= 
Bleomycin= 
Doxorubicin= 
5-fluorouracil=
Methotrexate=
A 
Cisplatin= acoustic n. injury, nephrotoxic
Vincristine= peripheral neuropathy 
Bleomycin= pulmonary fibrosis
Doxorubicin= cardiotoxic
5-fluorouracil= bone marrow suppression
Methotrexate= bone marrow suppression
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61
Q

History of which chemotherapeutic agent would require an FiO2 <30% and why

A

bleomycin d/t pulmonary fibrosis

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62
Q

Which 2 chemotherapeutic agents are antitumor antibiotics

A

bleomycin

doxorubicin

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63
Q

What are 5 hormones that regulate digestive activity

A
  1. gastrin
  2. secretin
  3. cholecystokinin
  4. gastric inhibitory peptide
  5. somatostatin
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64
Q

What are the functions for the following digestive hormones:
gastrin=
secretin=

A

gastrin= increases stomach acid when food enters stomach and stimulates chief cells to secrete pepsinogen

secretin= signals the pancreas to secrete HCO3 and the liver to secrete bile

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65
Q

What are the functions for the following digestive hormones:
Cholecystokinin=
Gastric inhibitory peptide=
Somatostatin=

A

Cholecystokinin= signals pancreas to release digestive enzymes and GB to contract

Gastric inhibitory peptide= slows gastric emptying, stimulates insulin release

Somatostatin= universal off switch for digestion

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66
Q

Gastrin:
production site=
stimulus=
function=

A

production site= G cells of stomach
stimulus= food in stomach
function= inc gastric acid, inc pepsinogen

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67
Q

Secretin:
production site=
stimulus=
function=

A

production site= S cells of small intestines
stimulus= acid in duodenum
function= inc pancreatic HCO3, dec gastrin secretion

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68
Q

Cholecystokinin:
production site=
stimulus=
function=

A

production site= I cells of small intestines
stimulus= food in duodenum
function= inc GB contraction, release bile, inc pancreatic enzymes, dec gastric emptying

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69
Q

Gastric inhibitory peptide:
production site=
stimulus=
function=

A

production site= K cells of small intestines
stimulus= food in duodenum
function= inc insulin release, dec gastric acid, dec gastric motility

70
Q

Somatostatin:
production site=
stimulus=
function=

A

production site= D cells pancreatic islet, stomach, small intestines
stimulus= food in gut, gastrin, CCK
function= dec all GI fxns

71
Q

Which GI hormone is increased in pts with Zollinger-Ellison syndrome

A

Gastrin d/t gastrin secreting tumor

72
Q

What is the cause of GB following a fatty meal

A

increased CCK release

73
Q

What gastric hormone treats carcinoid tumors

A

somatostatin

74
Q

What are the 2 factors that affect gastric barrier pressure

A
  1. LES tone

2. intragastric pressure

75
Q

What measure can decrease barrier pressure

A
  1. reduced LES tone

2. increase intragastric pressure

76
Q

What 3 things can decrease barrier pressure by decreasing LES tone

A
  1. anticholinergics
  2. cricoid pressure
  3. pregnancy
77
Q

What medication can increase barrier pressure by increasing LES tone

A

Metoclopramide

78
Q

How does succinylcholine affect gastric barrier pressure

A

It has a net 0 effect d/t increase in LES tone and increase in intragastric pressure that cancel each other out

79
Q

VIEW VIDEO of PONV

A

VIEW video on ponv 72 of 85

80
Q

Where does the vomiting center reside

A

the nucleus tractus solitarius in the MEDULLA

81
Q

3 sites that sensory input for the vomiting center originate

A
  1. chemoreceptor trigger zone
  2. GI tract
  3. Vestibular system
82
Q

How does sensory input from the GI tract stimulate nausea

A

Via 5-HT3 and NK-1 receptors

83
Q

How does sensory input from the CRT zone stimulate nausea

A

Via 4 mediators; 5-HT3, NK-1, DA-2 receptors, and noxious chemicals

84
Q

How does sensory input from the vestibular apparatus stimulate nausea

A

Via H1 and M1 receptors

85
Q

What are 6 anti-emetic drug classes

A
  1. 5-Ht3 antagonists
  2. Neurokinin-1 antagonists
  3. dopamine antagonists
  4. antihistamines
  5. anticholinergics
  6. steroids
86
Q

5-HT3 antagonists:
Receptor target=
Ligand=
examples=

A

Receptor target= 5-HT3
Ligand= serotonin
examples= ondansetron, dolasetron

87
Q

Neurokinin-1 antagonists:
Receptor target=
Ligand=
examples=

A

Receptor target= NK-1
Ligand= substance P
examples= Aprepitant

88
Q

Dopamine antagonist:
Receptor target=
Ligand=
examples=

A

Receptor target= D2
Ligand= dopamine
examples= droperidol, haloperidol, metoclopramide, prochlorperazine

89
Q

Antihistamines:
Receptor target=
Ligand=
examples=

A

Receptor target= H1, M1
Ligand= histamine, ACh
examples= scopolamine

90
Q

Steroids:
Receptor target=
Ligand=
examples=

A

Receptor target= intracellular steroid receptors
Ligand= steroids
examples= dexamethasone

91
Q 
Dose range for the following antiemetics:
Ondansetron=
Granisetron=
Dolasetron=
Aprepitant=
A 
Ondansetron= 4-8 mg
Granisetron= 1 mg
Dolasetron= 12.5 mg
Aprepitant= 40 mg
92
Q 
Dose range for the following antiemetics:
Droperidol=
Haloperidol=
Metoclopramide=
Prochlorperazine=
A

Droperidol= 0.625-1.25 mg
Haloperidol= 0.5-2 mg
Metoclopramide= 10-20 mg
Prochlorperazine=10 mg

93
Q

Dose range for the following antiemetics:
Diphenhydramine=
hydroxyzine=
promethazine=

A 
Diphenhydramine= 25 mg
hydroxyzine= 12.5-25 mg
promethazine= 12.5-25 mg
94
Q

What are 6 patient risk factors for PONV

A
  1. female
  2. nonsmoker
  3. h/o motion sickness
  4. previous PONV
  5. age youth>elderly
95
Q

What are 8 procedures that increase risk for PONV

A
  1. Long duration
  2. GYN procedures
  3. laparoscopy
  4. breast
  5. plastics
  6. strabismus
  7. orchiopexy
  8. T&A
96
Q

What are 5 anesthetic factors that increase PONV risk

A
  1. halogenated anesthetics
  2. N2O
  3. opioids
  4. etomidate
  5. neostigmine
97
Q

What anesthetic types can decrease PONV

A

RA or TIVA

98
Q

Why is the CTZ prone to emetic stimulation

A

The BBB is poorly developed around the CTZ so noxious chemicals can stimulate it (i.e. etoh, chemo)

99
Q

When should the timing of administration for dexamethasone and ondansetron occur intraoperatively

A 
dexa = with induction
zof = 30 min p/t emergence
100
Q

Which antiemetics can prolong QT

A

5-HT3 antagonists and droperidol

101
Q

Which antiemetics have the potential to cause extrapyramidal effects

A
  1. butyrophenones (droperidole)

2. metoclopramide

102
Q

Which antiemetic is contraindicated with bowel obstruction

A

metoclopramide d/t prokinetic effect

103
Q

Which antiemetics are contraindicated in pts w/ parkinsons and why

A

Dopamine antagonists d/t possibility of extrapyramidal effects (and pts are already on dopamine agonists)

104
Q

What causes motion induced nasuea

A

M1 and H1 stimulation in the vestibular system of the inner ear

105
Q

Which antiemetic target the vestibular system

A

scopolamine
diphenhydramine
hydroxyzine
promethazine

106
Q

Which anesthetic agent can produce antiemetic effects

A

Propofol 10 - 20 mg

107
Q

How is ephedrine used for PONV

A

25 mg IM can maintain BP and cerebral perfusion and decrease HoTN associated N/V

108
Q

what is a nonpharmacologic measure against PONV

A

P6 acupressure point

3 finger breadths below the wrist on inner forearm in between the 2 tendons

109
Q

What is the technical name for bone cement

A

Methyl methacrylate

110
Q

What is the purpose of bone cement

A

to bind implants to bones during ortho surgery

111
Q

What is bone cement effect on intramedullary pressures

A

It can be increased up to 500 mmHg

112
Q

What is the result of increased intramedullary pressure from bone cement

A

It can cause microemboli of fat, bone marrow, or cement, which can travel to the lungs

113
Q

What is the result of microemboli caused by bone cement

A

V/Q mismatch, increase in deadspace (V > Q)

114
Q

What is are 6 effects of methyl methacrylate if it enters the systemic circulation

A
  1. Bradycardia
  2. Dysrhythmias
  3. HoTN d/t dec SVR
  4. pulmonary HTN d/t inc PVR
  5. hypoxia
  6. cardiac arrest
115
Q

Which orthopedic procedure is associated with the highest risk of bone cement implantation syndrome

A

hip arthroplasty

116
Q

What are secondary procedures that increase risk for bone cement implantation syndrome

A
  1. knee arthroplasty
  2. vertebroplasty
  3. kyphoplasty
117
Q

What are the first 2 signs of BCIS in an awake pt under regional anesthesia

A
  1. dyspnea

2. AMS

118
Q

What is the first sign of BCIS in the pt under GA

A

decreased EtCO2

119
Q

What is the treatment process for BCIS

A
  1. 100% FiO2
  2. IV hydration
  3. phenylephrine (inc SVR)
120
Q

Fat embolism is a complication of what type of trauma

when is the risk greatest

A

long bone trauma

risk = greatest in first 72 hours after injury

121
Q

What are 3 risk factors for fat embolism

A
  1. pelvic fracture
  2. femoral fracture
  3. instrumentation of femoral medullary canal
122
Q

What is the triad of FES

A
  1. respiratory insufficiency
  2. neurologic involvement
  3. Petechial rash of neck, axilla, oral mucosa, and conjunctiva
123
Q

How does respiratory insufficiency from FES present

A
  1. hypoxemia
  2. bilat infiltrates on CXR
  3. ARDS
124
Q

Where does the petechial rash associated with FES present

A

Skin of neck and axilla
Oral mucosa
Conjunctiva

125
Q

Why is the maximum time for tourniquet inflation 2 horus

A

to decrease risk of ischemic damage

126
Q

Describe cell metabolism distal to tourniquets and the risks associated with it

A

Cells shift to anaerobic metabolism and byproducts accumulate as long as the tourniquet is inflated

127
Q

What are 2 ways that tourniquet release stresses the body

A
  1. restored blood flow to extremities produces a relative decrease in circulating blood volume
  2. Products of cellular hypoxia enter systemic circulation

Both can cause HoTN

128
Q

When the tourniquet is released, what are 5 transient physiologic changes that can occur

A
  1. increased EtCO2
  2. dec core body temp
  3. HoTN
  4. Dec SvO2
  5. Metabolic acidosis
129
Q

When can tourniquet pain begin following inflation

A

about 45-60 minutes

130
Q

What is the cause of tourniquet pain and how is it transmitted

A 
Cause = tissue ischemia
Transmission = C-fibers (slow pain)
131
Q

How does tourniquet pain respond to analgesia

A

It is unresponsive and can even breakthrough regional anesthesia

132
Q

How does tourniquet pain manifest under GA

A
  1. HTN

2. Tachycardia

133
Q

What are 3 results of COX-1 inhibition

A
  1. impaired plt function
  2. gastric irritation
  3. reduced renal BF
134
Q

When is COX-2 normally expressed

A

during inflammation

135
Q

What are 3 results of COX-2 inhibition

A
  1. analgesia
  2. anti-inflammatory
  3. antipyretic
136
Q

How is arachidonic acid activated

A

Phospholipase A2 acts on membrane phospholipids, producing AA

137
Q

Which COX enzymes are affected by NSAIDs and ASA

A

Both COX-1 and 2

138
Q

Name 6 non-selective COX inhibitors

A
  1. ASA
  2. ibuprofen
  3. naproxen
  4. ketorolac
  5. diclofenac
  6. indomethacin
139
Q

Name a COX-2 selective inhibitors

A
  1. celecoxib
140
Q

What are 3 CV complications associated with COX inhibitors

A

Inc risk for

  1. HTN
  2. MI
  3. HF
141
Q

Which COX inhibitor type is more prone to CV risks

A

COX-2 > COX-1

142
Q

How do COX inhibitors affect the pulmonary system

A

They decrease PGs which eventually cause bronchospasm

143
Q

What are hematologic complications associated with COX inhibitors

A

Plt inhibition and increased bleeding risk

144
Q

What are renal complications associated with COX inhibitors

A

Decreased PGs can cause dec renal BF

They should be avoided in pts with renal disease

145
Q

What pt should COX inhibitors be avoided

A

Pts with renal disease

146
Q

What CNS symptoms are associated with COX inhibitors

A

Tinnitus

147
Q

How can COX inhibitors affect bones

A

They can dec osteoclast and osteoblast activity and impair bone healing

148
Q

What are GI complications associated with COX inhibitors

A

gastric ulcers and bleeding

149
Q

How can COX inhibitors affect other drugs

A

NSAIDs displace albumin bound drugs and increase their concentration
Such drugs include warfarin, phenytoin, and valproic acid

150
Q

what is the morphine equivalent dose of ketorolac 30 mg

A

morphine 10 mg

151
Q

What is Samter’s triad

A
  1. asthma
  2. allergic rhinitis
  3. nasal polyps
152
Q

Which COX inhibitor exacerbates respiratory disease

A

ASA

153
Q

Which 5 herbal supplements can increase bleeding risk

A
  1. garlic
  2. ginkgo biloba
  3. ginger
  4. ginseng
  5. Saw palmetto
154
Q

Which 2 herbal supplements have sympathomimetic effects

A
  1. Ephedra (Ma Huang)

2. Ginseng

155
Q

How does long-term use of ephedra affect hemodynamic stability

A

It can deplete catecholamines and contribute to hemodynamic instability

156
Q

Which 2 herbal supplements can interact with MAOis and contribute to serotonin syndrome

A
  1. ephedra

2. St John’s Wort

157
Q

Which herbal supplement mimics the effect of aldosterone

A

Licorice

158
Q

Which 3 herbal supplements can prolong duration of anesthetic agents

A
  1. Kava Kava
  2. St John’s Wort
  3. Valerian
159
Q

Which herbal supplements can decrease MAC

By what mechanism

A
  1. Kava Kava
  2. Valerian

Mechanism = increases GABA

160
Q 
What are the key interactions of the following herbal supplements:
Garlic= 
Ginger= 
Ginkgo biloba= 
Ginseng=
A

Garlic= inc bleeding, dec glucose
Ginger= inc bleeding
Ginkgo biloba= inc bleeding
Ginseng= inc bleeding, enhanced SNS effects of sympathomimetics, dec glucose

161
Q

What are the key interactions of the following herbal supplements:
Ephedra=
Kava kava=
licorice=

A

Ephedra= MAOi interactions leading to serotonin sx, catecholamine depletion, sympathomimetic
Kava kava= dec MAC, prolong anesthetic
licorice= mimic aldosterone, Na+ and h2o retention

162
Q

What are the key interactions of the following herbal supplements:
Saw palmetto=
St. John’s Wort=
Valerian=

A

Saw palmetto= inc bleeding
St. John’s Wort= CYP3A4 induction, prolong anesthetic, interacts w/ MAOis causing SS
Valerian= dec MAC, prolong anesthetic

163
Q

Which herbal supplement can cause induction of CYP 3A4. What medications can be affected by this

A

St. John’s Wort

Meds = dec serum level of warfarin, protease inhibitors, and digoxin

164
Q

What are 4 MRI safe metals

A
  1. stainless steel
  2. titanium
  3. aluminum
  4. copper
165
Q

What 4 implants or debris should be verified before MRI

A
  1. PM/AICD
  2. aneurysm clipping
  3. metal implants
  4. implantable pumps
  5. shrapnel
166
Q

What color are MRI safe cylinders

A

Silver, with the color coded top

167
Q

According to closed claims analysis, what are the 4 most common causes of injury that result in claims

A
  1. regional anesthesia
  2. respiratory events
  3. CV events
  4. equipment failure
168
Q

What is the modified Aldrete scoring system

A

a measure to quantify readiness for discharge from PACU

169
Q

What Aldrete score indicates readiness for discharge

A

9 or greater

170
Q

What are the 5 domains of the Aldrete assessment

A
  1. activity
  2. respirations
  3. circulation
  4. consciousness
  5. O2 saturation

APEX-Miscellaneous (6 decks)

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