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Anesthesia based on Nebuchanedzzer II > Misunderstood/Diff Topic > Flashcards

Misunderstood/Diff Topic Flashcards

1
Q

True/False

Neuronal pathway for reflex withdrawal of a limb in response to a painful stimulus is mediated by the cerebral cortex.

A

False

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2
Q

_____ toxicity can develop in patients with renal failure who receive nitroprusside infusion.

A

Thiocyanate

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3
Q

Risk factors for development of persistent postoperative pain include
_______

A

psychosocial issues,

preoperative pain severity and postoperative pain severity.

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4
Q

During non-depolarizing neuromuscular blockade, fade with train-of-four stimulation is the result of ______

A

ion channel blockade at the neuromuscular junction.

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5
Q

Hepatopulmonary syndrome triad

A
  1. Liver dysfunction
  2. Hypoxia
  3. Intrapulmonary vascular dilation

*Unique positional change: worsening hypoxemia when standing, improved when supine

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6
Q

Portopulmonary HTN

A

Pulmonary HTN that exists in pt that has Portal HTN

- mean PAOP >25 mmHg at rest

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7
Q

How does magnesium prolong NMB?

A

Prejunction effects
- Inhibits Calcium channels at presynaptic junction -> prevent release of ACh

Post junctional effects
- decreases muscle fiber membrane excitability

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8
Q

Insulin exerts an (anabolic/catabolic) effect on the body

A

anabolic

  • Increases glucose uptake
  • Increases aa uptake
  • Increases fatty acid storage/synthesis

*insulin inibits catabolic processes (glycogenolysis, lypolysis, proteolysis), opposes glucagon and cortisol

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9
Q

Ideal time period to quit smoking is ___ weeks. Why?

A

4-8 weeks

  • decrease airway reactivity
  • increase bronchial ciliary motility -> enhance mucous clearance
  • decrease carbon monoxide lvls -> increase oxygen carrying capacity of hgb
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10
Q

Broken down Henderson-hasselbalach equation

A

pH = HCO3-/PaCO2 (kidneys/lungs)

*describes interrelated PaCO2, pH, and HCO3-

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11
Q

When does “anion gap” occur?

What is normal?

A

When metabolic acidosis occurs and the body has an excess of anions.
- The acid dissociates into H+ and an unmeasured anion. H+ is buffered by bicarb, and the unmeasured anion accumulates in the serum

Normal is 10 +/- 2

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12
Q

What is PaO2?

A

measurement of the oxygen tension in plasma
aka
Dissolved oxygen in plasma

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13
Q

Which analyzer is affected by water vapor, paramagnetic or galvanic?

A

Paramagnetic analyzers (ie: desflurane)

  • bc water vaper is diamagnetic, and will oppose the paramagnetic effect of O2
  • Paramagnetic devices are incorporated with a water trap from the sampled gas
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14
Q

Response to succinylcholine

  • GBS
  • MS
A

Upregulation of extrajunctional ACh receptors
and
increased hyperkalemic response to succs

*do not give

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15
Q

Response to succinylcholine

- Myasthenia gravis

A

Increased resistance to succinylcholine

*can be given

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16
Q

Response to succinylcholine

- Lambert-Eaton Myasthenic syndrome

A

Extremely sensitive to succs

*can be given

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17
Q

Guillan barre syndrome

- Autonomic dysfunction seen

A
  1. Labile BP
  2. Orthostatic Hypotension
  3. Arrhythmias
  4. Circulatory collapse
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18
Q

Every pt that receives anesthesia must have (4)

A
  1. Pre anesthesia eval
  2. w/in 48 hr to procedure, some elements no more than 30 d prior
  3. Review medical/surgical hx, meds, allergies, devel plan
  4. Post anesthesia eval w/in 48 h post surg
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19
Q

The _____ is the only organ that receives a dual blood supply. What happens if there is a reduction in blood flow?

A

liver
- hepatic a (25%) and portal v (75%)

Increase in adenosine in liver -> local arteriole dilation and increase in blood flow from hepatic a.

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20
Q

Desflurane has an extremely (High/Low) vapor pressure and is significantly vaporized at RT. How is this adjusted for?

A

High - 669 mmHg

Desflurane requires a heated vaporizer to maintain constant vaporizer output [ ], to account for evaporative cooling of des

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21
Q

3 major mechanisms for nitroprusside toxicity

A
  1. Cyanide ions bind to cytochrome C oxidase and inhibit cellular aerobic respiration
  2. Formation of cyanmethemoglobin (unable to carry O2)
  3. Thiocynate production (CNS related fx)
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22
Q

Local anesthetic systemic toxicity (LAST) usually occurs __ hours after the procedure

A

10-16h when plasma [ ] of local anes typically peaks

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23
Q

Prior to an awake intubation, percutaneous nerve blocks can be used to anesthetize the airway
- Transtracheal injection of local anesthetic will block ________, which provides _________

A

Recurrent laryngeal n., branch of vagus n.

- Sensory innervation to vocal folds and trachea

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24
Q

Most common risk of NSAID use in elderly

A

dyspepsia (20%)

*more than renal toxicity

25
Q

Dexmedetomidine (alpha 2 agonist) is metabolized ________.

A

in the liver, Cyt P450

- minimal changes noted with renal disease

26
Q

______ is the main mechanism for pt heat loss in the OR following initial redistribution of heat to the periphery

A

Radiation - 67%

27
Q

Bronchopulmonary dysplasia in preterm infants

  • What is it
  • Characterized by (4)
A

chronic disease of lung parenchyma, a sequelae of respiratory distress syndrome

Characterized by:

  • peribronchiolar fibrosis
  • disorganized pulmonary vasculature
  • airway smooth muscle hyperplasia
  • enlarged alveoli
28
Q

During electroconvulsive therapy, there is a brief initial ______ surge followed by a ______ response. How is this manifested in their monitor?

A

Parasympathetic
followed by sympathetic

Brief bradycardia
followed by significant tachycardia and HTN
- manage w/ esmolol, labetalol, nicardipine, clevidipine, nitroprusside

29
Q

With the hepatic arterial buffer response, hepatic arterial tone is modulated by ________ via _____ in order to maintain hepatic perfusion

A

portal venous flow via adenosine

30
Q

Effects on Hepatic arterial flow

  • Glucagon
  • Angiotensin II
  • Vasopressin
A
  • Glucagon: vasodilation

- Angiotensin II: vasoconstriction

31
Q

Treatment of tracheoesophageal fistula (can’t pass OG tube, excessive oral secretions) is ________

A

Kasai procesure - jejunal roux-en-y plus portoenterostomy

32
Q

VACTERL

A 
Vertebral abnl
imperforate Anus
Congenital heart disease
TracheoEsophageal fistula
Renal abnl
Limb abl
33
Q

How to prevent ECG burns in the MRI scanner

- Which law does this follow?

A

prevent any coiling or loops

- Faraday’s law: current in wire is directly proportional to the number of turns (coils) present

34
Q

Autonomic dysreflexia

  • Signs under GA
  • Signs awake/light anesthesia
A
  • Signs under GA: HTN, bradycardia

- Signs awake/light anesthesia: profuse sweating, facial erythema, piloerection, feeling of doom

35
Q

GCS mneumonic

A

Eyes (4)
Vocal (5)
Motors (6)

*# of letters in each category

36
Q

Partial compression of the aorta/IVC will cause _____ BP in the upper extremities and _____ in the lower extremities

A

increased

decreased

*ie: aortocaval compression > 20 weeks pregnancy

37
Q

____________ should be first line tx of bronchospasm during ETGA

A

increasing O2 [ ] to 100% (FIO2)

38
Q

What is unique in transplanted lungs?

A

Denervated and cough reflex and mucociliary function impaired

Lymphatic drainage absent

39
Q

Scopolamine, antimuscarinic can cause paradoxical ______ when given in low doses (0.1 mg)

A

paradoxical bradycardia

40
Q

PT/INR is typically increased in cirrhosis d/t ______

A

decreased production of coagulation factors in the liver

41
Q

Crawford classification of aortic aneurysms

  • I
  • II
  • III
  • IV
A
  • I: descending thoracic and upper abdominal
  • II: all or most of the descending thoracic and abd
  • III: inferior portion of the descending thoracic and most of the abd
  • IV: all or most of the abdominal aorta
42
Q

Crawford type __ aortic aneurysm has the greatest risk of spinal and renal ischemia

A

Type II

- mortality of 20%

43
Q

Spinal cord perfusion pressure =

A

MAP - CSFP

*cerebral spinal fluid pressure

44
Q

Spinal cord and kidneys are at risk for ischemic injury during open thoracoabdominal aneurysm repair. Protective techniques for spinal cord include __ (4)

A
  1. Shunts
  2. Bypass
  3. Hypothermia
  4. Spinal drain placement
45
Q

Why do obese pts rapidly desaturate with periods of apnea?

A

They have markedly reduced FRC, which narrows the gap btwn closing capacity and TV

*closing capacity: volume at which the respiratory bronchioles begin to collapse. residual volume + closing volume

46
Q

Treatment for postherpetic neuralgia

A
  1. TCA
  2. Opioids (tramadol - opioid + SNRI)
  3. Gabapentin/pregab

*NSAIDS are useless

47
Q

Glucagon (raises/lowers) blood glucose levels. How?

Glucagon (stimulates/impairs) lypolysis and (stimulates/impairs) glycolysis

A

raises by stimulating glycogenolysis and gluconeogenesis

Stimulates lipolysis
Impairs glycolysis

48
Q

__________ blocks provide fast, reliable, surgical anesthesia of the upper extremity, and are ideal for surgical procedures performed at or below the elbow

A

Supraclavicular block

49
Q

_______ blocks are best for shoulder and upper arm surgeries

A

Interscalene block

- proximal portion of the brachial plexus

50
Q

______ is a second messenger that causes smooth muscle relaxation, bronchodilation, vasodilation, and tocolytic effects.

A

cAMP

*also increases cardiac contractility

51
Q

Malignant hyperthermia is inherited in which fashion?

A

Autosomal dominant with incomplete penetrance

52
Q

What should you avoid in pts with sickle cell in the OR?

A 
Prolonged tourniquet time
Hypoxia
Dehydration
Cold
Acidosis
53
Q

Vasopressin’s structure is similar to _____ oxytocin. Differ by 2 amino acids

A

oxytocin

Exhibit cross reactivity at high plasma [ ].
Is: vaso can cause uterine contractions
Oxytocin can inhibit diuresis

54
Q

___ stimulates vasopressin secretion, while ___ inhibits secretion

A

AT2 (angiotensin II from RAAS)

ANP

55
Q

What type of info is seen on the National Practitioner Data Bank (NPDB)

A
  1. Medical malpractice payments
  2. Certain adverse licensure actions by state boards
  3. Certain adverse clinical privileges actions
  4. Certain adverse professional society membership actions
  5. DEA controlled-substance registration actions
  6. Exclusions from medicare, medicaid, and other federal healthcare programs
56
Q

On pressure support, a breath is triggered when a pt produces a _____ above a preset _____

A

flow rate

flow trigger

57
Q

What is the Time Constant?

A

The volume or capacity of the circuit (Vc) divided by the fresh gas flow (FGF)

Vc / FGF

58
Q

What accounts for the the most heat loss during GA?

A

Radiation - heat loss from infrared heat

59
Q

Dyspnea shortly after tumescent liposuction is most commonly caused by _______

A

Fluid overload and pulmonary edema

- injection of very large volumes of saline

Anesthesia based on Nebuchanedzzer II (38 decks)

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