Oral Board Flash Cards

Question 1

Oliguria

Answer 1

“PreRenal:
Hypovolemia, Hypotension, Hypoperfusion, Renal Artery/Vein stenosis/thrombosis, CHF, tamponade, ischemia
Renal
ATN, Intrinsic Disease, CRF
PostRenal:
Obstructed Foley, Ureteral/Urethral obstruction”

Question 2

Tachycardia

Answer 2

"Hypoxia
Hypercapnia
Dysrhythmia - SVT
Ischemia
Tamponade
PTX
Hypopvolemia
Anemia
Fever
Light Anesthesia
Pain
Medications - Pancuronium, Desflurane
MH
Pheo
Thryroid storm"

Question 3

Hypotension

Answer 3

"Preload:
Hypovolemia
Anemia
Medications
No venous return - PEEP, tamponade. PTX
Afterload:
Sepsis
Anaphylactoid/tic
Addisonian Crisis
Contractility:
Ischemia
Dysrhythmia
PTX
Tamponade
Valvular Disease
CHF"

Question 4

Hypoxia

Answer 4

"Wall to patient!
Wall disconnects
Circuit disconnects
Stuck valves
Inappropriate vent settings
Inappropriate FiO2
Kinked ETT
Malpositioned ETT
Obstructed ETT

Anemia

Dysrhythmia
Ischemia
CHF

PTX
Bronchospasm
Aspiration
Consolidation/PNA
VQ mismatch
PE
Effusion
COPD
Atelectasis

Brainstem injury
High spinal”

Question 5

Nausa/Vomitting

Answer 5

"Pain
Hypotension
Increased ICP
Medications
Vagal
Obstruction"

Question 6

Wheezing

Answer 6

"Upper Airway
Laryngeal edema
Laryngospasm
Laryngomalacia
Tumor/Polyp
Vocal cord paralysis
Infection
Lower Airway
Bronchospasm
Kinkend/plugged ETT
PTX
Cardiogenic
Anaphylaxis
Asporation
Carcinoid
PE"

Question 7

HTN

Answer 7

"Medications
Chronic HTN
Renal failure
Hypoxemia
Hypercarbia
Pain
Light anesthesia
Pheo
MH
Thyroid storm
Increased ICP"

Question 8

Agitation

Answer 8

"ABC's!!!
Med effect
Pain/Anxiety
Disorientation
Distended Bladder
Hypoxia
Hypercapnia"

Question 9

Bradycardia

Answer 9

"Primary Heart:
Sick sinus
Heart Block
MI
Reaction:
Hypoxia
Hypercarbia
Distended Atrium/Ventricle
Spinal cord injury
Brain stem injury
Vagal from surgeon retraction
Bladder distension
Medication"

Question 10

Hypercarbia

Answer 10

"Increased Production
Sepsis
MH
Thyroid storm
Decreased Elimination
Exhausted soda lyme
Stuck valvles
Low flows
Increased dead space or V/q mismatch
PE
Hypoventilation - SV underbreathing or inappropriate vent settings
"

Question 11

Indications for TEE

Answer 11

"Assessment of myocardial Fxn
Diastolic dysfxn
Accuracy of cardiac procedures
Air detection
Unexplained hemodynamic disturbance"

Question 12

Epidural Risks/Benefits

Answer 12

"Risks
Hypotension/Sympathectomy
High Spinal
LA toxicity
Arachnoiditis
HA
Back Pain
Benefits
Better pain relief
Improved respiratory fxn
Bowel motility
Decreased risk of DVT/PE"

Question 13

Risk factors for placenta previa

Answer 13

“Multiparity
Advanced age
Prior uterine surgery”

Question 14

Hypoxia on OLV

Answer 14

“1)Declare emergency, get help

2) Machine to pt, hypoxia difffernetial, especially cuff herniation
3) Hand ventilate, check for compliance
4) 100% FiO2, recruitment breaths
5) Check other monitors - ischemia
6) Auscultate
7) Suction
8) CPAP to operative lung
9) PEEP to non-operative lung
10) 2 lung vent
11) Clamp PA”

Question 15

ARDS Definition

Answer 15

“1)Acute onset

2) PaO2/FiO2 <200 - significant gradient
3) B/L infiltrates
4) PCWP <18, absence of signs of volume overload”

Question 16

Abnormal SSEP’s during case, causes

Answer 16

"Oxygenation
Ventilation
Temp
Anesthesic dose
Surgical instruments, retractors"

Question 17

Autonomic neuropathy Signs/Sx

Answer 17

"Early satiety
Neurogenic bladder
No Sweating
Resting tachycardia
Silent MI
No HR variability w respiration
Orthostasis
Insensitivity to propranolol or atropine
No HR response to hypovolemia
Sudden death"

Question 18

Causes of Decreased SVO2

Answer 18

“Decreased supply vs increased extraction
Decreased supply
Hgb - bleeding
Hypovolemia
Increased extraction
Hypermetabolic states - MH, Sepsis, Thyrotoxicosis”

Question 19

Pacemakers - Drugs to avoid

Answer 19

“Etomidate - myoclonus
Sux - fasiculations
Halothane - AV conduction defects
Lidocaine - decreased AV conduction”

Question 20

CEA post-op complications

Answer 20

“MI - #1 cause of morbidity after CEA
Neuro/stroke -
Cranial nerve injury
Respiratory - B/L CEA abolishes respiratory drive, predisposes to apnea”

Question 21

Indications for intubation

Answer 21

"Apnea
Inability to protect airway
Protection from aspiration
Potential airway compromise
GCS<9
Inability to maintain oxygenation"

Question 22

Severe Pre-eclampsia Criteria

Answer 22

"SBP>160
DBP>110
Signs of end organ damage
Proteinuria >5gm in 24 hours
Oliguria 
Pulmonary edema
Visual changes, HA's, MS change
RUQ pain/Impaired liver fxn
HELLP
TCP???
IUGR or oligohydramnios"

Question 23

Transfusion risks

Answer 23

"Infection - Hep B, Hep C, HIV
Volume overload
TACO
TRALI (1/5000)
Immune compromise
Febrile reaction (1/1000)
Hemolytic reaction (1/100,000)
GVHD"

Question 24

CBF

Answer 24

“Increases with PAO2 < 60
Coupled to CMRO2
Affected by temp, viscosity, vascular tone
Autoregulated when PaCo2 between 20-80”

Question 25

Rheumatic arthritis

Answer 25

"Atlanto-occipital instability, Decreased neck ROM TMJ stiffness, poor mouth opening Pulmonary - restrictive disease Pericardial thickening or effusion, myocarditis, CAD Pleural effusion, fibrotic lungs Anemia, Eosinophilia Adrenal insufficiency due to chronic steroid use Immunosuppression Liver dysfunction 2/2 methotrexate use"

Question 26

Discuss lung V/Q in OLV

Answer 26

"Obligatory R to L shunt through non-ventilated lung Shunt reduced by gravity as 60% of BF goes to non-op lung HPV - shunts 80% of BF to non-op lung Surgical compression - further shunts blood away from operative lung"

Question 27

Post-op pulmonary dysfunction

Answer 27

"Residual anesthetic Surgical trauma Post-op pain"

Question 28

5 T's

Answer 28

``` "Toxin - including anesthetic agents PTX Cardiac Thrombus PE Tamponade" ```

Question 29

Post-op Pneumonectomy complications

Answer 29

``` "Bleeding, HTX PTX RV failure, pulmonary edema Atelectasis PNA Bronchospasm Nerve injury - Phrenic, vagus, recurrent laryngeal Subclavian injury" ```

Question 30

Myasthenia: Non-depol vs Sux

Answer 30

Resistant to sux, sensitive to non-depols

Question 31

Problems w jet ventilation

Answer 31

"Barotrauma Unreliable delivery of anesthetic agent Secretions/blood pushed into trachea Inadequate CO2 elimination"

Question 32

Magnesium levels

Answer 32

``` "Normal = 1-2 Therapeutic = 4-8 6-10 = QRS widening >10 = loss of DTR's >15 AV block and respiratory arrest 25 = cardiac arrest" ```

Question 33

Newborn and anesthetics/Neuro-anesthesia

Answer 33

``` "Decreased protein binding Immature BBB Decreased drug clearance Decreased cerebral autoregulation - predisposes to edema Immature NMJ - sensitive to NMB More caudal extension of cord - L3" ```

Question 34

Cirrhosis manifestations

Answer 34

"MS changes, cerebral edema, encephalopathy, asterixis Increased blood volume, vascular permeability, low SVR, anemic, decreased albumin, bleeding 2/2 coags Increased abd pressure, aspiration risk, esophageal varices, GI bleed High CO, pericardial effusion, dilated cardiomyopathy Renal failure Pulmonary HTN, Pleural effusions, airway edema, decreased FRC"

Question 35

Risk factors for PPH

Answer 35

``` "HTN PEC Coagulopathy Abnormal Placentation Previous c/s, VBAC Cocaine/methamphetamine use Prolonged induction with pitocin Multiparity Polyhydramnios Chorioamnionitis Age <20 or >40" ```

Question 36

Anesthesia for COPD

Answer 36

"Consider regional Limit surgical duration, lap if possible Preop: smoking cessation, ABX, bronchodilators Multimodal pain management post op"

Question 37

Effects and risks associated with Intraop HTN

Answer 37

``` "Increased myocardial O2 consumption Increased LVEDP Leads to ischemia, subendocardium hypoperfused Stroke risk increased Renal dysfunction Bleeding risk" ```

Question 38

Factors that increase Pulmonary vascular resistance

Answer 38

``` "Hypoxia Hypercarbia Pain Acidosis Light anesthesia Nitrous Sympathetic discharge Hypothermia Alpha agonists - B2 agonists decrease PVR" ```

Question 39

Increased SVO2

Answer 39

Think cyanide toxicity or inadvertent wedge of PAC sampling pulmonary capillary blood, hypothermia