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APEX mock and stimulation notes > MOCK Exam #1 Notes > Flashcards

MOCK Exam #1 Notes Flashcards

1
Q

Prophylaxis for infective endocarditis no longer required for 4 procedures

A

Unrepaired cardiac valve disease
CABG
Coronary stenting
GI or GU procedures

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2
Q

Dental procedures involving _______and ________ requires prophylaxis for infective endocarditis?

A

Gingival manipulation and or damage to mucosal lining

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3
Q

Respiratory procedures requiring ABT prophylaxis for infective endocarditis

A

Those that perforate the mucosal lining with incision or BIOPSY

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4
Q

Congenital heart procedures requiring ABT prophylaxis for Infective endocarditis

A

Unrepaired cyanotic congenital heart defect
Repaired congenital heart defect within 6 months or with resideual defects near repair or graft. (this inhibits endotheliazation.

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5
Q

For heart transplant patient what is an anesthetic consideration for CO?

A

CO is more dependent on PRELOAD than on HR.

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6
Q

The transplanted heart is devoid or severed from what?

A

Severed from AUTONOMIC influence, meaning t

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7
Q

HR is determined by the

A

INTRINSIC RATE OF PHASE 4 depolarization which the TRANSPLANTED heart is not under that since they are severed from autonomic influence

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8
Q

In transplants patient the HR is

A

Fixed

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9
Q

In transplant patient the CO adjusts according to the

A

Position of the starling curves, increasing preload augment CO until it gets to a point where the ventricular myocytes becomes overstretched and CO falls

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10
Q

How does atropine reduces vagal tone

A

By acting as a competitive antagonist of the M2 receptor.

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11
Q

In the absence of vagal input as in ________, atropine has no effect.

A

Heart transplant

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12
Q

What drugs can be used to manipulate myocardial performance with the transplant patient?

A

Epinephrine

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13
Q

Transplant patient anesthetic consideration include

A

Maintain adequate preload to optimize the frank starling mechanism

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14
Q

Medications that should readily be available to augment the HR of transplant patient is

A

Isoproterenol and diluted epinephrine.

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15
Q

Ephedrine and Heart transplant patient

A

Indirect acting vasopressors, such as ephedrine, partially rely on endogenous catecholamines stores in the post synaptic sympathetic neurons and are therefore less effective.

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16
Q

With Heart transplant patient, will cholinesterase inhibitors cause bradycardia?

A

NO they won’t but they will still cause s/s of parasympathetic NS activation else where in the body.

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17
Q

With heart transplant patient, do you need to administer and anticholinergic with reversal

A

Yes.

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18
Q

what might you see on the ECG with a patient with a heart transplant?

A

May see 2 P waves, one for the recipient’s intrinsic rate of SA node and one from the donor heart.

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19
Q

For heart transplant the SA node of the native heart may

A

Still react to fluctuation in autonomic input, but this will not affect cardiac function.

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20
Q

For every 1 unit of PRBCs administered, the hgb and Hct should increase by

A

1g /dL

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21
Q

How can you estimate Hgb from Hct?

A

hct / 3

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22
Q

The spinal circulation consists of

A

2 posterior spinal

1 anterior spinal artery

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23
Q

Posterior spinal arteries arise from the

A

cerebella arteries

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24
Q

The cerebellar arteries supplies what region of the cord?

A

Dorsal (sensory) region of the cord

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25
Q

The anterior spinal artery arises from the

A

Vertebral arteries

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26
Q

Vertebral arteries supply what region of the cord?

A

Ventral (Motor) region of the cord

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27
Q

Both Anterior and posterior arteries received

A

collageral from the intercostal arteries in the thorax and the lumbar arteries in the abdomen. These

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28
Q

2 most appropriate intervention for “can’t ventilate and can’t intubate” Scenario

A

Surgical cricothyrotomy

Transtracheal Jet ventilation

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29
Q

Intubation technique best used when ventilation is possible?

A

Retrograde intubation

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30
Q

This airway technique Has no place in emergency airway management

A

Tracheotomy

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31
Q

Supraglottic , double lumen device place in the hypopharynx

A

Combitude

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32
Q

The proximal balloon of the combitude occlude the ______while the distal occludes the ______

A

Hypopharynx

Esophagus

33
Q

With the combitude, if the tip is placed in the esophagus can the lung be ventilated

A

Yes

34
Q

Should be release when placing the combitube?

A

Cricoid pressure.

35
Q

At what point during laparoscopy cholecystectomy is a gas embolism most likely to occur?

A

Initial Abdominal insufflation

36
Q

Gas embolism creates what?

A

air lock in the right heart and obstructs forward flow

37
Q

Signs and symptoms of gas embolism

A 
Decrease EtCO2
Increase EtN
Increase PAP
pulmonary edema
Decrease BP,
38
Q

Mill wheel murmur is associated with

A

Gas embolism

39
Q

Most sensitive indicator of gas embolism

A

TEE

40
Q

Aging what happen to lung elastic recoil, what is the implication

A

Lung elastic recoil is loss leading to an Increased lung compliance. Lung elastic recoil is vital in maintaining airway diameter. Losing that ability lead to collapse of the lung prematurely. Causes trapping which increases RV

41
Q

2 first signs of PE

A

Precipitous fall in EtCO2

Tachycardia

42
Q

Most of the reported cases of retrograde intubation described its use in patient with

A

Cervical spinal injuries.

43
Q

This block anesthetize the vocal cords prior to an away intubation?

A

transtracheal

44
Q

This reflex forces LA on the vocal cord during a transtracheal block?

A

cough reflex

45
Q

What is the most reliable method to reduce postop pulmonary compications

A

Smoking cessation.

46
Q

Anesthesia for VATS for removal of bullae preferred ventilation strategies? Why>

A

Small TV and High RR (it minimizes intra-alveolar pressures, HFJV is an alternative to PPV)

47
Q

They are large air-filled spaces in the lung that result from damage to normal alveolar tissue?

A

Bullae

48
Q

If bullae are ruptured, it can lead to ?

A

Pneumothorax
Tension pneumothorax
Cardiovascular collapse

49
Q

To reduce the risk of rupture bullae the patient should be allowed to

A

Spontaneously ventilate until the chest is opened.

50
Q

This ventilation can increase tension and may result in rupture of the bullae>

A

Positive pressure

51
Q

Unilateral vagus nerve injury lead to

A

Hoarseness

52
Q

Bilateral vagus nerve injury lead to

A

Aphonia

53
Q

Unilateral External branch of the SLN injury

A

Min effects

54
Q

Bilateral External branch of the SLN injury

A

Hoarseness, easily fatigue

55
Q

Bilateral Internal branch of the SLN injury

A

NO effect BECAUSE IT IS SENSORY ONLY

56
Q

Bilateral RLN injury

A

Stridor, dyspnea (acute) aphonia (chronic)

57
Q

Sizing below 3 of LMA

A

< 5kg = 1
5-10 = 1.5
10-20 = 2
20-30 = 2.5

58
Q

Inspiratory pacemaker is the

A

Dorsal respiratory center

59
Q

Primarily responsible for caring active exhalation

A

Ventral respiratory center

60
Q

Triggers inhalation

A

The apneustic center stimulates the DRC

61
Q

Triggers END of inhalation

A

Pneumotaxic center inhibits the DRC

62
Q

Le Fort that are associated with basilar skull fractures

A

Le Fort 2 and 3

63
Q

Le Fort that are associated with Disruption of the cribriform plate

A

Le Fort 2 and 3

64
Q

When should you not attempt a nasal intubation?

A

When there is a CSF lead in the nose or the ears
Raccoon eyes
Periorbital edema

65
Q

Classic presentation of the oculocardiac reflex is

A

Profound bradycardia

Hypotension

66
Q

What is a potential side effect of losartan?

A

Hyperkalemia

67
Q

What type of medication is losartan?

A

Angiotensin II receptor antagonist

68
Q

2 hypertensive medications that can increase maternal and fetal mortality

A

Losartan and ACEI

69
Q

2 hypertensive medications that can cause post-induction hypotension (vasoplegia)? How do you treat it

A

ACEIs
Losartan

Consider vasopressin 0.5 - 1 units
OR methylene blue (1-2mg/kg)

70
Q

Cardioversion initial fist shock is

A

50-100 Joules

71
Q

A shock delivered on the ___________ or _ wave can lead to v-tach or v-fib

A

Relative refractory period

T-wave

72
Q

Based on the 2016 ACC/AHA guidelines, elective surgery should be postponed for at least ________after a Current generation DES is placed

A

6 months

73
Q

Elective surgery should be postponed for at least ________after a BARE METAL STATE is placed

A

30 days (1 month)

74
Q

Name drugs that interfere with SSEPs

A 
BDMNP
Barbiturates
Diazepam
Midazolam
Nitrous
Propofol
75
Q

Name drugs that DO NOT interfere with SSEPs

A 
KEDOD
Ketamine
Etomidate
Dexmedetomidine
Opioids
Droperinol
76
Q

Drugs the interfere with the accuracy of SSEPs tend to ______amplitude and ___latency

A

Decrease amplitude

Increase latency

77
Q

What does decrease amplitude mean?

A

The intensity of the stimulus

78
Q

What does increase latency mean?

A

Time it takes for the stimulus to travel from point A to point B

79
Q

Resume at question 30

A

Resume at question 30

APEX mock and stimulation notes (1 decks)

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