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Areviewbook > New Book Anesthesia > Flashcards

New Book Anesthesia Flashcards

1
Q

ARDS

A

Acute onset
PAOP<18
Diffuse bilateral opacities
Pa02:Fi02<200 if 300 it is ALI

Mechanical ventilation is not a requirement

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2
Q

No hypercarbia not good with

A

Increased ICP

Pulmonary HTN

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3
Q

Thiopental

A

Large volume of distribution and insignificant hepatic metabolism

Therefore same duration in patient with liver disease

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4
Q

Factor 7 first to become deficient in

A

Liver disease
Vitamin K deficiency
Warfarin therapy

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5
Q

Liver disease

A

Thrombocytopenia
Low levels factor 2 5 7 9 10 11
Vitamin k deficiency
Increased tPA levels

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6
Q

Clinical uses factor 7

A

Hemophilia
Congenital missing factor 7
Reverse warfarin
Reversal of direct factor 10 inhibitors

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7
Q

ALP not raised by

A

Osteoporosis

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8
Q

Low albumin is indicator of

A

Poor hepatic function

Not good in acute disease due to long half life

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9
Q

Low SAAG

A

Malignancy
Nephrotic syndrome
Infection

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10
Q

AST/ALT ratio<1 in

A

Viral hepatitis

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11
Q

ALP

A

Excreted in bile

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12
Q

ALP is high but GGT is low in various

A

Bone diseases

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13
Q

Liver disease see increase in

A

CO
Decrease SVR
Increased O2 in mixed venous
Decreased portal vein/hepatic blood flow

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14
Q

Relieving ascites May lead to greater venous capacitance and thus

A

Hypotension

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15
Q

Hyperinflation with emphysema thus lose elastic recoil of alveoli by loss of elastic tissue and surfactant

A

Read it

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16
Q

Reasonable maneuvers to minimize PEEPi include

A

Low tidal volume
Reduce respiratory rate
Low I:E
Increase insporatory flow to delivery tidal volume in short time to reduce I:E and increase expiratory time

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17
Q

FEV1 less than 30% sign of

A

Very severe COPD

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18
Q

Stop smoking

A

6 to 8 wks before surgery is best

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19
Q

Neuraxial can preserve

A

FRC
Preserve RR
Hypotension

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20
Q

General anesthesia

A

Lower FRC

Atelectasis

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21
Q

Venovenousbypass

A

Pulmonary or air embolus and thrombosis possible

Rarely used

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22
Q

OSA leads to

A

Difficult mask ventilation

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23
Q

Lipophilic drugs

A

Higher volume of distribution

Longer to clear from body

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24
Q

For succ and cisatracurium use

A

TBW

Not broken down by organs so not IBW

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25
Q

Roc/Vec use

A

IBW

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26
Q

Obese individuals

A

Blood volume
Stroke volume
Cardiac output increase to provide circulation to adipose tissue

Left ventricular hypertrophy

Increased incidence of hypotension on induction

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27
Q

Decreased FRC in obese due to

A

Reduction in ERV and chest compliance!

DLCO is preserved in obese

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28
Q

Propofol maintenance dosing by

A

TBW

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29
Q

Kidney is autoregulation for

A

MAP 60 to 160

Renal system gets 20% of blood flow

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30
Q

Diabetes inspidus common after

A

Head injury

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31
Q

Mannitol leads to

A

Hyponatremia associated with high serum osmolality

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32
Q

Reversal agents same dosage in those with

A

Kidney disease

Morphine and meperidine have metabolites dependent on kidney for excretion

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33
Q

Best preserved mechanism for temperature regulation with general anesthesia

A

Sweating

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34
Q

Conduction lowest form of

A

Heat loss

Highest is radiation

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35
Q

Vasodilation from epidural leads to heat loss due to

A

Redistribution from core to periphery

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36
Q

More wound infections and coagulopathy with

A

Hypothermia

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37
Q

Postop hypothermia increases

A

Sympathetic nervous system activity

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38
Q

Hypothermia causes MAC to

A

Decrease

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39
Q

Thyroid storm is

A

Life threatening

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40
Q

Too much thyroid hormone increases

A

RR and TV

Increased CO

Increase basal metabolic rate up to 60 to 100%

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41
Q

MH vs thyroid storm

A

MH has metabolic acidosis, profound hypercarbia and muscle rigidity not found in thyroid storm

CPK is increased in MH but decreases in thyroid storm

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42
Q

Thyroid storm treatment start with

A

Restoring intravascular volume, glucose, and electrolytes

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43
Q

Don’t use ASA with

A

Thyroid storm

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44
Q

Propranolol is best for

A

Thyroid storm

45
Q

Do surgical decompression for a

A

Hematoma

46
Q

Airway obstruction immediately after Extubation after thyroidectomy due to

A

Bilateral recurrent laryngeal nerve injury

47
Q

After 24 hours of thyroidectomy respiratory obstruction due to

A

Hypocalcemia

48
Q

Thyroid storm can occur during intraop

A

Thyroidectomy

49
Q

Most pheo

A

Solitary tumors at a single adrenal gland usually the right side

50
Q

Pheo is part of

A

MEN type 2a or 2b

51
Q

Alpha blocker therapy improves mortality in patients with

A

Pheo

52
Q

Phenoxybenzamine is

A

Long acting 24-48 hours
Non competitive pre and post synaptic alpha blocker
Give 10mg q8

53
Q

Orthostatic hypotension is an affect of

A

Alpha blockers

54
Q

Don’t need to use steroids for

A

Pheochromocytoma

55
Q

Labetalol

A

Alpha blocker and beta blocker

56
Q

Hypotension or hypertension possible post

A

Pheo removal

HTN if some of the pheo is still present

Hypoglycemia is also possible but not hyperglycemia

57
Q

Recurrence of signs of MH post dantrolene mean you need additional dose of

A

Dantrolene

58
Q

Dantrolene vials contain

A

Mannitol

59
Q

Most specific early sign of MH is

A

Muscle rigidity

60
Q

Most sensitive sign of MH is

A

Hypercarbia

61
Q

Dantrolene blocks

A

Calcium release from SR

Drug of choice in treatment of MH

62
Q

MH hyperventilate with C02

A

Hyperventilate with 100% oxygen at flows of 10 L/min

63
Q

Cocaine blocks reuptake of

A

Norepinephrine serotonin dopamine

64
Q

Don’t give just beta blocker to patient with

A

Cocaine abuse

65
Q

Restoration of p50 of Hgb within a few days of quitting

A

Smoking prior to surgery

Will also reduce carboxyhemoglobin levels

66
Q

Opioids given before to asthma patients can prevent

A

Bronchospasm

67
Q

Management of intraop bronchospasm

A

Deepen anesthesia with volatile agent
Beta agonists
Minimize barotrauma
Epinephrine especially if anaphylaxis triggered bronchospasm

68
Q

Young adult post Extubation male think

A

Negative pressure pulmonary edema

69
Q

Post Extubation pulmonary edema

A

Bilateral fluffy infiltrates

Don’t do diuresis

70
Q

Aortic dissection first steps include

A

Aggressive blood pressure control with nitroprusside and labetalol infusions

71
Q

Profound systemic hypotension likely to occur after removal of

A

Aortic cross clamp

72
Q

Decreased arterial pH or worsening acidemia leads to

A

Activation of chemoceptors

73
Q

Cerebral hyperperfusion syndrome

A

When blood flow to brain exceeds metabolic demand

74
Q

Baroceptor leads to decreased

A

Heart rate
BP
Cardiac output and increase in venous dilation

75
Q

Downregulation of beta receptors

A

CHF

76
Q

Decreased blood viscosity improves

A

Systemic blood flow

77
Q

Higher hematocrit leads to

A

Reduction in peripheral blood flow

78
Q

Hematocrit

A

Percentage composition of whole blood composed of erythrocytes

79
Q

CPP=

A

MAP-ICP

80
Q

Dobutamine is not a good choice of pressor without evidence of heart failure bc it predisposes to

A

Arrhythmia

81
Q

Tricuspid valve insuffiency with

A

PE

82
Q

Nitroprusside inhibits

A

HPV this lowering Pa02

83
Q

ADH released in response to

A

Surgical stress

84
Q

SBP goes up as you travel further from

A

Aorta

85
Q

FFP indicated for

A

Treatment of micro vascular bleeding for inr>1.5

Don’t give preventatively or as volume expander

86
Q

Bleeding into closed space such as brain eye or spine demands immediate reversal of

A

Antucoagulation

If on ASA or clopidogrel give platelets to reverse

Usually if < 50000 you transfuse

87
Q

DDAVP for

A

Central diabetes insipidus

Helps uremic renal failure patients prevent bleeding

88
Q

Hetastarch

A

Impairs renal function

Can cause coagulopathy leading to increased surgical blood loss

89
Q

Von wildebrand can affect

A

PTT but not PT

90
Q

PT

A

Normal 11 to 14 seconds

5 7 10 factors are a part of it

91
Q

Warfarin affects

A

PT time

92
Q

VWD

A

If you just found out delay the surgery and get a hematology consult

93
Q

VWD type 3 is severe

A

Treat by giving vWf and factor 8

94
Q

Dextran has

A

Anticoagulant properties

95
Q

Check for TRALI by

A

Sending a specimen to blood bank for antibody antigen cross match

96
Q

All blood products carry

A

Infectious risks

97
Q

Most common noninfectious adverse reaction from blood product transfusion

A

Transfusion related immunomodilatoon

98
Q

Leukoreduction

A

Remove wbcs from red blood cells

99
Q

Isovolumetric relaxation

A

After closure of aortic valve until mitral valve opens associates with lowest ventricular volume

100
Q

Late stages of phase 4 of SA node action potential

A

ICaT

101
Q

L type Calcium channels open and cause depolarization during

A

Phase 0 of SA node action potential

102
Q

Slowest rate of conduction of all cardiac tissues is

A

AV node

103
Q

Starling law compares

A

Cardiac output to LVEDP

If no other variables it should be linear, the heart pumps what it gets

104
Q

Increase in contractility shifts frank starling curve to the

A

Left

105
Q

Increase in afterload causes Frank starling curve to go

A

Down and to the right

106
Q

Preload affects

A

Same line on frank starling curve

Afterload and contractility form new lines

107
Q

Most myocardial oxygen consumption during

A

Isovolumetric contraction phase

108
Q

Lambert Eaton affects both

A

Depolarizing and no depolarizing blockers and makes you more sensitive to them

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