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Mock exam 1 Flashcards

1
Q

lipophilic opioids in continuous epidural infusion most likely provide analgesia by:

A
  • acting systemically
  • fentanyl, sufentanil
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2
Q

hydrophilic opioids in continuous epidural infusion most likely provide anesthesia by:

A
  • acting in the spinal cord
  • superior analgesia
  • morphine, hydromorphone
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3
Q

Most appropriate interventions for “can’t intubate, can’t ventilate” situation

A
  • surgical cric
  • transtracheal jet ventilation
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4
Q

Methadone

A
  • only narcotic known to prolong QTi
  • torsades de points
  • antagonizes NMDA, inhibits 5HT & NE, agonizes opioid receptors
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5
Q

LA made of 3 components:

A
  1. Aromatic ring
  2. Intermediate chain
  3. Tertiary amine
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6
Q

Aromatic ring

A

confers lipid solubility

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7
Q

Intermediate chain

A

determines metabolism & allergic potential

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8
Q

Tertiary amine

A

confers H2O solubility

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9
Q

Allergic reaction more common in ester or amide LA?

A

ester (1 “i”)

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10
Q

Allodynia

A

nonpainful stimulus evoking painful response

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11
Q

Hyperalgesia

A

exaggerated pain response

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12
Q

Neuralgia

A

pain localized to a dermatome

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13
Q

Dyesthesia

A

abnormal painful sensation

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14
Q

Recommended bladder width of BP cuff

A

40% of the circumference of the extremity

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15
Q

BP cuff that is too small will give a fale

A

high reading

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16
Q

BP cuff that is too large will give a false

A

low reading

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17
Q

Conditions that increase risk of endocarditis & warrant ABX prophylaxis

A
  • previous infective endocarditis
  • prosthetic heart valve
  • heart transplant w/ valvuloplaty
  • unrepaired cyanotic congenital heart defect
  • dental procedures
  • resp procedures that perforate mucosal lining
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17
Q

West Zone 1

A
  • dead space
  • P alveolar > P arterial > P venous > P intersitial
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18
Q

West Zone 2

A
  • matched V/Q
  • P arterial > P alveolar > P venous > P interstitial
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19
Q

West Zone 3

A
  • shunt
  • P arterial > P venous > P alveolar > P interstitial
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20
Q

West Zone 4

A
  • increased pressure in interstitium (pulmonary edema)
  • P arterial > P intersitial > P venous > P alveolar
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21
Q

Bullae

A
  • large air-filled spaces
  • rupture can lead to pneumo, tension pneumo, CV collapse
  • To prevent rupture: SV until chest opened
  • small Vt w/ high RR to minimize intra-alveolar pressure
  • AVOID N2O
  • DLT airway of choice
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22
Q

Amine

A

NR3

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23
Q

Alcohol

A

ROH

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24
Ether
ROR'
25
Ester
RCOOR
26
Risk factors ischemic optic neuropathy post spine surgery
- Wilson frame - Greater EBL - Low ratio of colloid:crystalloid resuscitation - male - obese - long surgery
27
Direct current cardioversion
Indications: - aflutter, afib - 1st shock = 50-100 j - increase incrementally to max 360 j
28
Cutting tip needle
- Quincke - Pitkin increased risk of PDPH
29
Pencil point needle
- Sprotte - Pencan - Whitacre decreased risk of PDPH
30
Round bevel tip needle
Green
31
Spinal cord protective strategies during thoracic aorta coss slamp
- hypothermia (30-32 C) - CSF drainage - Proximal HTN - avoid hyperglycemia - partial CPB - steroids, CCBs, mannitol
32
Gas embolism
- "air lock" in right heart - S/S 1. Dec EtCO2 2. Inc PAP 3. Pulm edema 4. low BP 5. hypoxia 6. dysrhythmias 7. cyanosis 8. mill wheel murmur * TEE most sensitive indicator
33
Greatest risk of gas embolism during laparoscopic surgery
initial insufflation
34
Na+ nitroprusside & SpO2
- dilates pulm vasculature - counteracts HPV - increases intrapulm shunt (zone III) - decreases SpO2
35
Pyloric stenosis electrolyte & acid/base imbalance
- olive-shaped mass - projectile vomiting - low K+, H+, Cl- - hypokalemia, hypochloremic, metabolic alkalosis
36
Losartan
- angiotensin II antagonist - SE: hyperkalemia - increases lithium reabsorption - avoid in pregnancy - vasoplegia
37
Treatment of vasoplegia resistant to volume, neo, epi, NE
vasopressin
38
lung volume that increases w/ age
residual volume
39
Abdominal compartment syndrome
- IAP > 20 - decreases CO, venous return - increases SVR - decreases diaphragmatic excursion
40
MAP formula
MAP = (SBP x 1/3) + (DBP x 2/3)
41
complication of rapid correction of chronic hyponatremia
central pontine myelinolysis
42
Drugs to avoid w/ carcinoid crisis
- sux - atracurium - thiopental - epi - NE - isoproterenol
43
Consequences of inadequate pain control in pt undergoing abdominal surgery
- decreased Vt, VC, TLC, FRC - inability to clear secretions - hypoxia - atelectasis - SNS stimulation - PLT aggregation & venous stasis - increased urinary sphincter tone - urinary retention
44
Recommended timing of epidural placement
- individualized - after approved by OB, ok to proceed
45
Drugs that interfere w/ SSEPs
- decrease amplitude & increase latency - VA, N2O, propofol, barbs, benzos
46
Drugs that do NOT impair w/ SSEPs
- ketamine - precedex - etomidate - opioids - droperidol
47
Unilateral RLN injury
hoarseness
48
Bilateral RLN injury
- stridor - dyspnea - aphonia (chronic)
49
Aldrete score
50
Dorsal resp group
inspiration
51
Ventral resp group
expiration
52
Apneustic center
stimulates DRG
53
Pneumotaxic center
inhibits DRG
54
Elderly have ______ clearance & _____Vd
decreased, decreased
55
Bleomycin
- pulmonary fibrosis - at risk for O2 toxicity - Keep FiO2 < 30% to maintain SpO2 > 90%
56
Piston ventilator
- electric - will not consume O2 tank in pipeline failure - PP relief valve opens if circuit pressure > 75 - Negative pressure relief valve opens at - 8
57
LFT: assess synthetic function
- PT - INR - albumin
58
LFT: assess hepatocellular injury
- AST - ALT - GST
59
LFT: assess cholelithiasis
- alk phos - GGTP
60
Opioid receptor
- GPCR - inhibit adenylyl cyclase - block conversion of ATP to cAMP - pre-syn nerve - reduced Ca+ conductance decreases NT release - post-syn nerve - increased K+ causes hyprepolarization
61
Glucagon
- antagonizes insulin - stimulates gluconeogenesis in liver - produced by alpha cells in pancreas - causes N/V - increases myocardial contractility by increases cAMP - useful for BB OD, CHF, low CO
62
Distance from subclavian CVC to CAJ
10 cm
63
Distance from RIJ CVC to CAJ
15 cm
64
Distance from LIJ CVC to CAJ
20 cm
65
Distance from femoral vein CVC to CAJ
40 cm
66
Distance from right median basilic vein CVC to CAJ
40 cm
67
Distance from left median basilic vein CVC to CAJ
50 cm
68
CBF decreases _____ ml/100g/min for every ___ mmHg PaCO2 (directly proportional)
1-2, 1
69
PE
- decrease EtCO2 - tachycardia - increased CV filling pressures - hypotension Tx: 100% FiO2, HD support w/ fluids, inotropes
70
Transplanted heart
- severed from autonomic influence - HR is determined by intrinsic rate of phase 4 depolarization of SA node (100-120 bpm) - HR fixed - CO dependent on preload - use direct-acting drugs (isoproterenol, epi) - indirect (ephedrine) less effective - 2 p waves on ekg
71
Oculocardiac reflex
- five & dime / V (trigeminal) & X (vagus) -Tx: remove stimuli, 100% O2, anticholinergic
72
Most common causes of perioperative allergic reactions
NMBs > Latex > ABX > Protamine
73
Best drug for extraction of retained placenta
- NTG - relaxes uterus - facilitates manual removal - venous > arterial
74
cocaine dose
1.5 - 3.0 mg/kg not to exceed 200 mg
75
Bite on tongue blade > 5 sec
50% receptor blockade (most sensitive)
76
DB stimulation w/o fade
60% receptor blockade
77
TOF 4/4
70% receptor blockade
78
Vt 5 ml/kg
80% receptor blockade
79
Brugada syndrome
- ion channelopathy - common in males from Southeast Asia - RBBB w/ ST elevation in precordial leads V1-V3
80
WPW
- paroxysmal SVT - short PRi, delta wave, wide QRS
81
Lenegre's dz
- His-Purkinje defect - long pauses, wide QRS, brady
82
Mannitol
- inhibits H2O reabsorption in PCT & LOH - dose = 0.25-1 gram/kg
83
Hydralazine
- increases cGMP - arterial > venous dilation - bareceptor reflex preserved - tachycardia common - dose = 2.5-20 mg IV - can cause lupus
84
Postop delirium
acute confusion occurs 1-5 days postop
85
Final products of soda lime reaction
- sodium hydroxide (NaOH) - calcium carbonate (CaCO3)
86
Nightshade (Belladonna)
- Anticholinergic OD - S/S result of muscarinic antagonism - flushing, mydriasis, dry mouth, confusion, hallucinations, hyperthermia, tachycardia - " red as a beet, blind as a bat, dry as a bone, mas as a hatter, hot as a hare" -Tx: physostigmine - increases Ach available at muscarinic receptors
87
Most common causes of hypocalcemia in the OR
- hyperventilation (reduces ionized ca+) - administration of citrated blood products greater than 1.5 ml/kg/min
88
1 U PRBC increases Hgb by
1 g/dL
89
1 U PRBC increases Hct by
2-3%
90
Nerve fibers that transmit tourniquet pain
- C fibers - slow pain - tourniquet pain begins 45-60 min after inflation
91
RCA monitored by which leads & supplies which part of heart?
- II, III, aVF - RA, RV, SA/AV node, inferior LV
92
LAD monitored by which leads & supplies what part of heart?
- V3-V5 - anterolateral LV
93
Circumflex monitored by which leads & supplies what part of heart?
- I, aVL - Lateral LV
94
Near-infrared spectroscopy
- assesses cerebral venous O2 sat - monitors regional cerebral ischemia
95
C1 esterase inhibitor deficiency
- hereditary angioedema - increased bradykinin - Tx: FFP (contains C1 esterase)
96
B:G sevo
0.65
97
B:G iso
1.4
98
B:G des
0.42
99
B:G N2O
0.47
100
Effects of tourniquet release
- CO2 builds up in ischemic limb - delivers large amounts of CO2 to pulmonary circulation - transiently increases EtCO2 - dysrhythmias, hypotension, bradycardia, decreased temp
101
Pheo
- catecholamine secreting tumor (NE > epi) - S/S = HA, diaphoresis, tachycardia - Block alpha BEFORE beta (A comes before B) - Tx: BB, alpha blockers, Nitroprusside
102
Joule Thompson effect
gas stored at high vapor pressure that is suddenly release escapes form its container into vacuum. Temp falls. Explains why O2 cylinder opened quickly feels cool to touch
103
dermatome bladder procedures
T11-L2
104
dermatome prostate & bladder neck procedures
S2 - S3
105
dermatome for TURP
T10
106
Retrograde intubation
- puncture cricothyroid membrane & pass wire through VC out mouth - ETT loaded over wire & advanced into trachea - mostly used in c-spine injuries - contraindications: goiter, neck flexion deformity, coagulopathy
107
Ulnar nerve injury
- more common in males, obese, cardiac surgery, pre-existing nerve patho - pronation on armboard increases risk - ideal on armboard = supination - ideal tucked = neutral
108
Gastroschisis
- right of umbilicus - not covered by sack - prematurity
109
Omphalacele
- midline - covered by sac - associated w/ congenital defects: beckwith, heart dz, trisomies 13/18/21, cantrell
110
superior rectus eye movement
supraduction (CN 3)
111
inferior rectus eye movement
infraduction (CN 3)
112
medial rectus eye movement
adduction (CN 3)
113
lateral rectus eye movement
abduction (CN 6)
114
superior oblique eye movement
intorsion/depression (CN 4)
115
inferior oblique eye movement
extorsion/elevation (CN 3)
116
BMI formula
kg/m^2 inch to cm = in x 2.54 cm to meter = cm / 100
117
adenosine should not be given to which pt d/t increased risk of bronchospasm?
asthma
118
Non-OB surgery
- delay until 2nd trimester - fetal risks: growth restriction, LBW, demis, preterm labor - avoid N2O, benzos - regional if appropriate - fetal monitoring
119
________________ is the most reliable method to reduce postop pulmonary complications
smoking cessation
120
therapeutic index
TI = LD50/ED50

APEX mock exam topics (1 decks)

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