Oral Boards Flashcards

Question

Phase II block

Answer 1

- Usually with 2.5mg/kg SCh - inactivation of receptors due to prolonged stimulation phase - Fade with twitch and tetanus

Answer 2

- Pros: Can improve microcirculatory flow (increased O2 delivery) - Cons: expensive, Worsened edema with non-intact endothelium (whether pulm, cerebral etc)

Answer 3

- Ischemia until proven otherwise - Preexisting? - Acute change in Demand/Tachycardia? - Acute MI, ischemia - ↑↓[K], ↑[Ca2+] - Hypothermia - C-section/Vaginal delivery

Answer 4

- Hyperosmolarity - Hypokalemia - L shift - Worsened intracellular acidosis

Answer 5

- Hoarseness (dysphonia) - Dysphagia - OSA - ↑ PAP - Laryngospasm

Answer 6

- Bilateral pulmonary infiltrates - Petechial rash (conjunctiva, oral mucosa, neck folds) - Hypoxemia/ resp distress - Increased PA pressure - Hypotension - AMS - Usually occurs with long bone fracture

Answer 7

- 6-9% Volume/weight loss - *↓skin turgor/cap refill (2-3s)* - *Deep respirations +/- tachypnea* - UOP ≤1cc/kg/hr - Specific Gravity 1.020-1.030 - Tachycardia - Orthostatic HoTN - Dry mucous membranes - Hearing loss - Sunken fontanelle

Answer 8

- ETCO2 should be relatively normal due to high solubility of CO2 - ↑PAP

Answer 9

- New onset of HTN and proteinuria or the new onset of hypertension and significant end-organ dysfunction with or without proteinuria after 20 weeks of gestation - SBP >140 and/or DBP > 90 meets criteria - End organ dysfunction: SEE OTHER FLASHCARD

Answer 10

- HoTN - Severe pain - Loss of fetal heart tones

Answer 11

- Screen= recipient plasma mixed with commercial RBCs | - Cross= recipient plasma mixed with donor RBCs

Answer 12

- 1 mcg/kg epi - No vasopressin, calcium, lido - 1.5mg/kg Intralipid 20% emulsion - CPR and airway

Answer 13

Deepen anesthesia - Albuterol - Low dose Epi, Lidocaine - Mehtylprednisolone (wont help acute but prevents future) - Subq 1:1000 epi at 0.1 mL/kg

Answer 14

- Sodium nitrate (oxidizes Hgb→MetHgb→↑affinity of cyanide to MetHgb but then if O2sat↓ → give Methylene Blue) - Thiosulfate - *Vit B*

Answer 15

- Assess field for diffuse oozing - CBC, INR, TEG - Products (PLT, Cryo, FFP) as needed

Answer 16

- FLUIDS - Insulin - D5W when Glu is 250 - K when UO returns and when K is back to normal

Answer 17

- if <6.0mEq → Diuretics, IVFs, Albuterol, Insulin, hyperventilate, Kayexalate (if time) - if >6/symptomatic→ 0.5g CaCl2, 1amp Bicarb, Glucose 50cc of D50 + insulin; DIALYSIS!

Answer 18

- Treat underlying cause (PTX? EBL? Surgical compression?) - Confirm accuracy - 100% O2

Answer 19

- Confirm SaO2  - ↑FiO2 to 100%  - Hand ventilate  - Visualize ETT and circuit  - Auscultate bilaterally - Laryngoscopy to confirm ETT placement

Answer 20

- Elevate Head of bed - Hyperventilate to PaCO2 25-30mmHg - HTN control while maintaining CPP - Drugs: Furosemide/Mannitol, Dexamethasone, Paralysis, - Drain CSF if drain exists

Answer 21

``` - First address anemia, hypovolemia Then, 2 goals: 1) *↑ Myocardial O2 supply (Hgb, CPP, NTG) 2) *↓Myocardial O2 Demand (βBlockers) - EKG/Troponins ```

Answer 22

- Check Foley, obtain urine sample - Review volume administered - Draw BMP (check for changes in Cr) - Fluid challenge: bolus of 500cc - Mannitol (low dose .25mg/kg)

Answer 23

- Ondansetron (5HT3 antagonist) - Droperidol/Metoclopramide (D2 antagonist) - Scopolamine (anticholinergic) - Promethazine (H1 Blocker) - Benzos/Propofol (GABA-A agonist) - Tigan

Answer 24

- Bedrest - Hydralazine/BP control - Magnesium for seizure (goal: 4-6mEq/L) - Epidural if PLT ok

Answer 25

- Uterine Massage - Oxytocin - Methylergonovine - PgF2a (carboprost) - Prostaglandin E/Misoprostol - Emergency hysterectomy with ligation of uterine/internal iliacs

Answer 26

- Ischemia - Hypokalemia - Hypomagnesemia

Answer 27

- "Oxygenation, Ventilation, and Circulation" - Qualified anesthesia personnel - EKG - BP cuff - Temp - O2 and capnograph - Pulse Oximeter

Answer 28

VAST: - Vasodilation - Anticonvulsant - Sedative, skel muscle relaxant (dec sens to ACh) - Tocolytic

Answer 29

- ↑Glycine + ↓Na→ transient blindness - Transient HTN then HoTN may indicate ↓↓Na - Cardiac (100/120mEq levels) - Postop SIADH - Ammonia toxicity (glycine): delayed awakening - Spinal is choice of anesthetic to monitor for AMS

Answer 30

- Fever - TACO (100) - TRALI (10k) - Hemolytic/L-T Rxn - HBV >HCV >HIV/HTLV

Answer 31

- Preexisting: Essential, Renal, AH - Surgical, SNS - Hypoxemia, Hypercarbia - Medication - Volume Overload - ↑ICP - Laryngoscopy - Emergence

Answer 32

SO much METH - Sepsis, Overfeeding (TPN) - Mainstem - MH - Exhausted soda lime, ↓FGF - Thyroid storm - ↑Temp/Fever - ↑airway resistance ↓elimination (COPD, CHF, PTX) - Laparoscopy/CO2 embolism - Tourniquet release

Answer 33

- PE - Bronchospasm - PTX - Pulmonary Edema - Pleural Effusion - Pulmonary aspiration - Intraperitoneal insufflation - Kinked ETT - Stuck expiratory valve - Mucous Plug - Chest wall rigidity (narcotic or ↓paralytic)

Answer 34

- Iatrogenic- bair hugger - Infection - Illicits/Rx- MAOi TCA cocaine amphetamines - Transfusion Reaction - Thyroid storm - MH - NMS - Pheochromocytomas

Answer 35

- Light anesthesia - Hypoxemia, Hypercarbia - Hypovolemia/Hypotension - Hyperthermia - "PAST TIME" - PE, Anaphylaxis, Storm, Transfusion txn, Tumors (pheo/carcinoid),Ischemia, MH, Electrolytes, Tension Pneumo

Answer 36

- Preexisting - CNS/hypothalamus - Drugs - Redistribution to periphery - Heat loss (radiation- EM wave loss)

Answer 37

- Hypoxemia, Hypercarbia - ↓Preload, ↓Intravascuar volume - Arrhythmias - PEEP, AutoPEEP, Gravid Uterine, PTX - Sympathectomy/↑Venous capacitance/ Spinal Shock - Anaphylaxis - Sepsis, shock - BMP: Hypocalcemia, Hypoglycemia, Acidemia - Cardiogenic- shock, HOCM, AS/AR, Mitral Stenosis, Tamponade, CHF

Answer 38

- Hypoxemia, Hypercarbia - Vagus- Oculocardiac reflex, Baroreceptor, ↑ICP, Pneumoperitoneum, Laryngoscopy - Drugs: Beta Blockers, Narcotics, Amio, Dex/Clonidine, ND-CCB - ↓Temperature/hypothermia

Answer 39

- Low FiO2 - Hypoventilation - V/Q mismatch- shunt, PNA, ARDS, OLV/Mainstem, Embolism, ↓FRC - Circulation CHF, MI - Blood: Anemia, Cyanide, CO, MetHgb - Seizures

Answer 40

- Prerenal: CHF, HoTN/Hypovolemia, Abdominal Compartment Syndrome, Shock, Pneumoperitoneum, Aortic cross clamping - Renal: ATN, Nephritis - Postrenal: Ureter stones, Foley kink

Answer 41

- CSWS & SIADH ↓ serum Na and osm, ↑ urine Na - CSWS associated with hypovolemia - SIADH associated with euvolemia - DI = loss of free H2O, ↑ serum Na and ↓ urine osm

Answer 42

- Insert IO needle into the tibia at 10-15 degrees caudal angulation (to avoid the epiphyseal plate), located 1-2cm below and 1 cm medial to the tibial tuberosity - Advance needle until a "pop" or reduced resistance is felt

Answer 43

- Non-cardiogenic pulmonary edema - Occurs 1-6hrs after administration of any blood product (most commonly plasma-containing products) - Pathophysiology: transmission of donor leukocyte antibodies activates neutrophils in the lungs -> factor release, endothelial damage, capillary leakage, and ALI - SSx: fever, chills, tachycardia, dyspnea, hypoxemia, hypotension, pulmonary edema, pink frothy pulm secretions - Dx: hypoxemia (P:F <300, SpO2 <90%) and pulmonary edema (b/l chest infiltrates) WITHIN 6 HRS OF TRANSFUSION in the absence of heart failure or volume overload (PAOP <19) Tx: stop transfusion, increase FiO2, notify the blood bank, support ventilation as necessary; diuretics and steroids are NOT indicated in TRALI

Answer 44

- Cardiac: Cardiomyopathy, ventricular dysrhythmias, MR - Pulm: ↓ pulmonary reserves, ineffective cough, recurrent pneumonia, chronic aspiration, sleep apnea - Other: macroglossia, difficulty swallowing, increased bleeding (dystrophin abnormalities -> ↓ vasoconstrictor response)

Answer 45

1) correct hypoxemia, hypercarbia, hypotension, hypovolemia, anemia 2) make sure anesthetic depth is stable 3) ask surgeon to rule out surgical causes of spinal cord injury 4) (in peds) perform a wakeup test if signals remained abnormal

Answer 46

- Dx: acute hypotension and ↓ ETCO2 - Tx: 1) Tell surgeon to flood surgical field with saline 2) ↑ FiO2 to 100% 3) Attempt to aspirate air through central venous line 4) Administer fluids 5) Administer vasoconstrictors and inotropes (and compressions) as necessary 6) Place in left lateral decubitus to facilitate air going to the RA and avoid outflow tract obstructions

Answer 47

- Awake/cooperative - Airway & gag reflexes intact - NMBDs reversed - Vital capacity >10 mL/kg/breath - Vt > 6mL/kg/breath - NIF >20 cmH20 - SpO2 > 90% on FiO2 40-50% w/ < 5 of PEEP - RSBI < 100 breath/min/L

Answer 48

- Stimulation of INHIBITORY cardiac receptors (by stretch, chemicals or drugs) ➙ ↑ parasympathetic tone/ ↓ sympathetic activity ➙ bradycardia, vasodilation, hypotension

Answer 49

- Cardiac: HTN, resting tachycardia, painless MI, dysrhythmias - GI: early satiety, prolonged postprandial fullness, nocturnal diarrhea, bloating, GERD, N/V - Other: peripheral neuropathy, impotence, lack of sweating

Answer 50

- Relief of tension pneumothorax | - 14g needle inserted into the 2nd intercostal space at the midclavicular line

Answer 51

1. Drugs that stimulate tumor cells - SCh, histamine-releasing drugs (morphine, atracurium) 2. Drugs that ↑ sympathetic activity: atropine, pancuronium, ketamine, ephedrine 3. Droperidol, metoclopromide, ephedrine

Answer 52

- Headache, vision changes/papilledema, altered mental status - Cushing's Triad of HTN, bradycardia, change in respiratory pattern (or wide pulse pressure)

Answer 53

Findings that suggest difficult airway: - Small mouth opening - Poor cervical spine mobility - Retrognathia - Large tongue - Prominent incisors - Short neck - ↓ Thyromental distance ( <6.5 cm) - Mallampati III or IV

Answer 54

- Grade 0 = unruptured aneurysm - Grade 1 = aSx or minimal HA and slight nuchal rigidity - Grade 2 = mod-severe HA, nuchal rigidity, no neurologic deficit other than CN palsy - Grade 3 = drowsiness, confusion, mild focal deficits - Grade 4 = stupor, mod-severe hemiparesis, early decerebration, vegetative disturbance - Grade 5 = deep coma, decerebrate rigidity, moribund **Note: higher grades are associated with the presence of vasospasm, ICH, ↑ surgical mortality

Answer 55

1. ) Neurogenic pulm edema: sympathetic surge ➙ systemic/pulm vasoconstriction ➙ ↑ pulm volume/ ↓ LV compliance ➙ ↑ pulm pressures and capillary permeability 2. ) Vasospasm: develops 3-12 days after SAH, peak days 6-7; presents with neurologic deterioration/drowsiness; dx made with angiography or TCD; treat with NIMODIPINE, HYPERTENSION, NORMOVOLEMIA (previously Triple-H) 3. ) Re-bleed: usually within the first 24-48h, up to 2 weeks 4. ) Dysrhythmias & EKG abnormalities: due to ↑ ↑ catecholamine release with SAH; long-QT/deep T-wave inversions; pHTN/sHTN 5. ) E- abnormalities: hyponatremia from CSWS or SIADH

Answer 56

Ischemia happens when there is an inadequate O2 supply to meet the metabolic demands - Causes of decreased supply: tachycardia, anemia, hypoxia, decreased CPP (hypotension, coronary vasospasm/obstruction, severe AS/AR, elevated LVEDP) - Causes of increased demand: tachycardia, increased wall tension, contractility, increased afterload

Answer 57

- Pulmonary: hypoxia (VQ mismatch), bronchospasm, pneumothorax, post-op respiratory failure, pulmonary htn - Heart failure from pHTN and cor pulmonale - GI: coagulopathy (hepatic involvement and vit k malabsorption), psuedocholinesterase deficiency, diabetes, electrolyte abnormalities

Answer 58

1) preoperative anxiety 2) young age (1-5yo) 3) post-op pain 4) use of less-soluble volatiles (sevo/des) 5) type of surgery 6) prolonged surgical duration

Answer 59

**GET UPDATED INFORMATION!

Answer 60

• Large volumes of hypotonic solution absorbed through disrupted venous sinuses ➙ circulatory overload, hypo-osmolality, hyponatremia, & solute toxicity By System: • CV: hypertension, reflex brady, circulatory depression, pulm edema • NEURO: confusion, restlessness, seizures, visual disturbances, coma, death • RESP: pulm edema, hypoxia • HEME: DIC & hemolysis (from hypotonicity) • RENAL: renal failure • METABOLIC: acidosis

Answer 61

1) Secure the airway with an ETT 2) Provide circulatory support with pressors and inotropes as indicated 3) Place an arterial line and draw ABG, BMP, glucose, Cr 4) 12-lead EKG 5) Tx hyponatremia with fluid restriction, diuretics, hypertonic saline, anticonvulsants 6) Monitor and treat DIC and anemia

Answer 62

1) obtain blood cultures prior to Abx 2) administer empiric broad-spectrum abx 3) control the source of infection 4) administer fluids (crystalloids first line), pressors (Norepi first line), and inotropes as necessary to maintain MAP >65, UOP >0.5mL/kg/hr, normal lactate 5) blood products as necessary 6) corticosteroid therapy when lactate is ↑ and SpO2 ↓ despite adequate resuscitation 7) administer insulin to keep BG < 180 mg/dL 8) bicarb for pH < 7.15 9) mechanical ventilation with PEEP, ↓ Vt, and Pplat < 30 cmH2O 10) minimal sedation, avoid NMB 11) DVT and stress ulcer ppx 12) daily spont ventilation trials

Answer 63

``` • Bladder or capsular perforation • Bleeding • Coagulopathy • Transient bacteremia/septicemia (post-op) • Hypothermia • Toxicity of irrigating fluids - Glycine tox: transient blindness - Ammonia tox: neurologic sequelae, n/v, convulsions, coma ```

Answer 64

Elective non-cardiac surgery should be delayed 14 days after balloon angioplasty, 30 days after BMS placement, and optimally 6 months after DES placement. If noncardiac surgery is required, I would reach a consensus decision with the surgeon (and cardiologist if possible) as to the relative irks of surgery and discontinuation of DAPT. Elective noncardiac surgery may be considered after 3 months in newer DES if the risk of postponing surgery is greater than the risk of discontinuing DAPT.

Answer 65

SQ: check platelets, no delay needed IV: placement/removal 2-4h after discontinuation of heparin; re-start heparin 1 hour after placement of catheter

Answer 66

- Delay needle instrumentation 12 hours following low-dose LMWH and 24 hours following high-dose LMWH

Answer 67

1. Place pt in Trendelenurg (drain contents from lungs) 2. Apply cricoid pressure 3. Suction oropharynx 4. Intubate 5. 100% oxygen 6. Suction trachea 7. Apply PEEP after suctioning 8. Suction stomach with OGT 9. Order baseline ABG and CXR 10. Monitor for 24-48hr * * NO PROPHYLACTIC STEROIDS OR ABX

Answer 68

- α-blockade for at least 7-10 days (phenoxybenzamine, phentolamine) - BP < 165/90 - Restoration of intravascular volume - Echo, ECG, CXR to evaluate cardiac function (dilated cardiomyopathy, ectopy, ischemia) - B-blocker for rate control

Answer 69

- α-blockade for at least 7-10 days (phenoxybenzamine, phentolamine) - BP < 165/90 - Restoration of intravascular volume - Echo, ECG, CXR to evaluate cardiac function (dilated cardiomyopathy, ectopy, ischemia) - B-blocker for rate control

Answer 70

* Ensure normothermia * Correct anemia, e- abnormalities, metabolics * Turn on alarms * Recalibrate/zero transducers * Check lung compliance and initiate ventilation * Ensure heart is de-aired * TEE to assess function/PA cath for numbers * Midazolam to prevent awareness during rewarming

Answer 71

* Ensure normothermia * Correct anemia, e- abnormalities, metabolics * Turn on alarms * Recalibrate/zero transducers * Check lung compliance and initiate ventilation * Ensure heart is de-aired * TEE to assess function/PA cath for numbers * Midazolam to prevent awareness during rewarming

Answer 72

Relative Contra: 1) Pre-existing Hgb-opathy 2) Contamination with drugs 3) Contamination with clotting agents 4) Contamination with urine, bone chips, amniotic 5) Pts with pheochromocytoma 6) Malignancy Absolute Contra: 1) Microbial contamination 2) Cancer surgery with high risk of direct tumor rupture

Answer 73

* PaO2 > 60 on FiO2 <50% * PaCO2 < 50 mm Hg * pH > 7.3 * Vital Capacity > 15 mL/kg * PEEP < 5

Answer 74

* Phase 1: pHTN (pulm vasospasm), hypotension (RHF), hypoxia (V/Q mismatch), seizure, cardiac arrest * Phase 2: LV failure, pulmonary edema, coagulopathy

Answer 75

1) Oversized ETT 2) Multiple intubation attempts 3) Intraop position changes 4) Surgery duration > 1hr 5) Traumatic intubation 6) 1-4 years old 7) Coughing 8) Volume overload 9) coexisting URI

Answer 76

``` Cardiac: • Valvular disease • LV hypertrophy • HTN • CAD • Cardiomyopathy ``` ``` Non-Cardiac: • Hyperthyroidism • PE • Excessive EtOH • Caffeine intake ```

Answer 77

1) CKD 2) Renovascular disease 3) Chronic steroid therapy (Cushing's) 4) OSA 5) Drugs 6) EtOH abuse 7) Obesity/metabolic syndrome 8) Thyroid disease 9) Pheo 10) Coarctation of aorta

Answer 78

1) Recommend use of bipolar electrocautery 2) Place return plate as far from pacer as possible 3) Disable tachydysrhythmia detection/therapy (shock) 4) Place defibrillator pads 5) Reprogram device to asynchronous mode (pacer) 6) Recommend surgeon does short bursts of EC if monopolar is needed

Answer 79

- Pacemaker: magnet *may* set to asynchronous mode - AICD/Pacer: *will not* set pacing function to asynchronous, usually disables tachydysrhythmia sensing and treatment function

Answer 80

- Full, fast, and forward - Adequate preload - Relative tachycardia (decreases diastolic time) - Relative low SVR (reduce regurgitant fraction)

Answer 81

- Symptom triad: angina, syncope, CHF | - Severe AS: gradient > 50, AVA < 1.0

Answer 82

I want to: avoid tachycardia (or extreme bradycardia), maintain normal sinus rhythm and SVR.

Answer 83

Ascertain the patient's smoking history, use of inhalers, productive cough, worsening dyspnea, baseline symptoms.

Answer 84

1. D/C triggering agents 2. Call for help. 3. 100% FiO2, high flow, hyperventilate 4. Dantrolene 2.5 mg/kg IV q5min until sx subside 5. Collect ABG, E-, calcium, LFT, CK 6. Treat hyperkalemia: hyperventilate, dextrose + insulin 7. Active cooling: ice to groin/axilla 8. Maintain UOP >2 mL/kg/hr w fluids, lasix, mannitol

Answer 85

1) Avoid LA overload - Avoid tachycardia - Aggressively treat dysrhythmias 2) Avoid dropping LA pressures - Fluid to maintain BP & CO 3) If pt has pHTN, avoid exacerbations 4) Maintain SVR **Full (volume), normal HR, maintain SVR

Answer 86

- Keep warm, dry, clear airway - If HR < 100bpm: PPV, SpO2 monitoring - If HR < 60: consider intubation + epi and chest compressions

Answer 87

- PA Pressure: 25/10 (mean ~15) - CO: 4-8 L/min - CI: 2-4 L/min - Mixed Venous O2 (SvO2): 60-80% - EF 55-70%

Answer 88

``` RA: 0-5 mmHg RV: 25/5 PA: 25/10 (diastolic step up) LA: < 12 LV: 120/10 ```

Answer 89

- Severe HA, altered mental status, blurred vision - Pulmonary edema - GI: epigastric/RUQ pain, liver infarct, elevated LFTs - HELLP syndrome - Thrombocytopenia/pathia (note: coag studies are usually normal) - AKI (elevated Cr), oliguria

Answer 90

- SBP >160 or DBP > 110 | - OR if pt has BP > 140/90 with signs of end organ dysfunction

Answer 91

1. Cardiac: r/o CHF due to anemia, hypoxia 2. Pulm: discuss h/o acute chest syndrome 3. Neuro: assess any deficits from strokes/seizures 4. GU: assess renal function

Answer 92

1. Indication for placement 2. Manufacturer 3. Pacer dependent rhythm? 4. Last time interrogated? 5. Affect of magnet placement 6. Reprogram pacer/disable anti-dysrhythmia if dual AICD/pacer

Answer 93

1. Indication for placement 2. Manufacturer 3. Pacer dependent rhythm? 4. Last time interrogated? 5. Affect of magnet placement 6. Reprogram pacer/disable anti-dysrhythmia if dual AICD/pacer

Answer 94

- Unstable atrial fibrillation, atrial flutter, atrial tachycardia, and SVTs. - If medications fail in the stable patient with the before mentioned arrhythmias, synchronized cardioversion will most likely be indicated.

Answer 95

I would place supplemental oxygen while assessing for adequate oxygenation, ventilation, hemodynamic stability and the presence of a pulse. Assuming the patient were stable, I would order a 12-lead EKG and consult cardiology. If this were a true monomorphic VT, I would treat with adenosine and then amiodarone (if adenosine did not work). If at any point the patient becomes unstable (even with a pulse), I would sedate and secure the airway and perform immediate synchronized cardioversion.

Answer 96

I would confirm true pulselessness, begin chest compressions, and defibrillate immediately after verification of a shockable rhythm. If pulselessness persists, I would immediately resume BLS, intubate, and give 1mg epinephrine every 3-5 min. I would continue to defibrillate every 2 minutes until the rhythm changes. I would also send an ABG and correct any metabolic or electrolyte abnormalities. I would administer bicarb if ACLS lasted greater than 10 minutes or if pH < 7

Answer 97

The primary goal in managing the pregnant trauma patient is to resuscitate and stabilize the mother. However, to address unique concerns with a pregnant patient, I would ensure LUD positioning with in-line stabilization, prepare for difficult airway management and aspiration, monitor FHR and uterine contraction, and assess for membrane rupture, uterine rupture, or placental abruption. I would also prepare for emergent delivery of the baby.

Answer 98

The primary goal in managing the pregnant trauma patient is to resuscitate and stabilize the mother. However, to address unique concerns with a pregnant patient, I would ensure LUD positioning with in-line stabilization, prepare for difficult airway management and aspiration, monitor FHR and uterine contraction, and assess for membrane rupture, uterine rupture, or placental abruption. I would also prepare for emergent delivery of the baby.

Answer 99

* Tumor releases histamine, kallikrein, serotonin; symptomatic only if mets or primary outside intestine * Urine 5-HIAA to diagnose

Answer 100

* Carcinoid syndrome is a constellation of symptoms that results when excessive amounts of vasoactive hormones (histamine, kallikrein, seritonin) are secreted into the blood stream, causing upper body flushing, bronchoconstriction, diarrhea, right-sided heart disease (TR or PS), hypotension or hypertension. * Tricuspid regurgitation most common lesion, TS/PR/PS occur but less commonly * Hepatomegaly, peripheral edema, DOE suggest significant RHF from valvular lesion

Answer 101

* Perioperative administration of octreotide to reduce serotonin secretion from the tumor (best 2d-2w before surgery) * Optimize volume status, as patients are typically hypovolemic * Axiolysis to prevent stress-induced tumor release * H1 and H2 blockers to attenuate the effects of histamine * α and β blockers to prevent catecholamine-mediated release * Steroids

Answer 102

1. SVC syndrome: dyspnea, headache, edema above the shoulders, chest pain, dysphagia, orthopnea, hoarsness, nasal stuffiness, pleural effusions, cough, AMS, facial cyanosis. 2. Paraneoplastic syndromes (Humoral hypercalcemia, SIADH, LEMS, Cushings, carcinoid) 3. Pancoast

Answer 103

1. Humoral hypercalcemia: tumor release of PTH-related peptides; presents with muscle weakness, cardiac arrhythmias, n/v, renal failure. 2. SIADH: tumor secretion of ADH, leading to hyponatremia, decreased serum oSm, increased urine osm; euvolemic 3. Cushing's Syndrome: increase ACTH release, leading to hypokalemia, alkalosis, HTN, psychosis 4. LEMS: commonly associated with small cell carcinomma 5. Carcinoid syndrome

Answer 104

Risk factors for PPH include augmented labor, chorioamnionitis, fetal macrosomia, maternal obesity, multifetal gestation, preeclampsia, primiparity

Answer 105

Rx: 1. Oxytocin 2. Carbaprost 3. Methergine 4. Misoprostol 5. TXA Surgical: 1. Hysterectomy 2. Uterine aa. embolization 3. Uterine aa. ligation 4. Uterine balloon tamponade

Answer 106

First, I would warm, dry, and stimulate the neonate. I would then position the airway and only suction if I believed there was an obstruction. I would use supplemental air or oxygen to maintain targeted goals. If the baby's HR was < 100 or it was apneic or gasping, I would provide positive pressure ventilation and place a pulse oximeter. If after 30s of PPV the HR was < 60, I would intubate, start chest compressions, and establish IV access through the umbilical vein. If after 60s the HR was still < 60 I would give epinephrine and replace volume with normal saline.

Answer 107

First, I would warm, dry, and stimulate the neonate. I would then position the airway and only suction if I believed there was an obstruction. I would use supplemental air or oxygen to maintain targeted goals. If the baby's HR was < 100 or it was apneic or gasping, I would provide positive pressure ventilation and place a pulse oximeter. If after 30s of PPV the HR was < 60, I would intubate, start chest compressions, and establish IV access through the umbilical vein. If after 60s the HR was still < 60 I would give epinephrine and replace volume with normal saline.

Answer 108

``` 1 minute = 60-65% 2 minute = 65-70% 3 minute = 70-75% 4 minute = 75-80% 5 minute = 85-95% ``` Newborns > 35 weeks - start with room air Newborns < 35 weeks - start with 21-30% FiO2

Answer 109

1. Inadequate mask ventilation 2. Chest compressions initiated / HR < 60 sustained 3. Need for prolonged intubation 4. Need for ETT medication 5. Special circumstances (CDH, low birth weight)

Answer 110

1. Uterine atony 2. Retained placental parts 3. Placental accreta 4. Uterine rupture 5. Coagulopathy

Answer 111

* Excessive intraabdominal pressures > capillary filling pressure -> reduced organ perfusion (oliguria, reduced lactate metabolism, coagulopathy, translocation of intestinal bacteria) * Impaired ventilation secondary to cephalad displacement of the diaphragm and decreased FRC * Decreased venous return, increased afterload -> cardiac depression * Elevated ICP * Increased PVR

Answer 112

• Risk of undiagnosed dystrophinopathy, and despite the lack of outward symptoms, the disease can still lead to a proliferation of extrajunctional AChR -> life-threatening rhabdomyolysis + hyperkalemia

Answer 113

1. Hypokalemic periodic paralysis 2. Hyperkalemic periodic paralysis 3. King Denborough Syndrome 4. Central Core Disease

Answer 114

1. Cancel the case 2. Administer dantrolene 3. Monitor for myoglobinuria, generalized rigidity, hypermetabolic state, electrolyte disturbances 4. Check creatine kinase (CK) 5. Admit the patient, work up for MH and undiagnosed muscular dystrophy

Answer 115

1. Remove SCh syringes from the room 2. Disengage vaporizers 3. Replace circuit and CO2 absorbent 4. Flush anesthesia machine 5. Ensure the presence of iced solutions, monitors, and dantrolene

Answer 116

Decreased PO2 along with a mixed metabolic and respiratory acidosis. The beginning stages of MH show a purely respiratory acidosis.

Answer 117

Continue dantrolene 1mg/kg every 6 hours for 24-48h to prevent relapse.

Answer 118

* Risks to mother include failed intubation, aspiration, hemorrhage, infection, thromboembolism. * Risk to the fetus include preterm delivery, teratogenesis (highest risk during 1st trimester), fetal asphyxia, IUGR, miscarriage, and neurotoxicity * Laparoscopic surgery carries further risks, including trochar damage to the gravid uterus, hypercapnia-induced fetal acidosis

Answer 119

* Short Neck * Macroglossia * Subglottic stenosis * Mandibular hypoplasia * Atlanto-axial, atlanto-occipital instability

Answer 120

1. Orthodromic AVRT: narrow QRS (regular) because the cardiac impulse travels through the AV node and returns retrograde from the ventricle -> atrium via the accessory pathway. Treat with vagal maneuvers first, then treat with medications that slow conduction through the AVN (adenosine, BB, verapamil, amiodarone). Synchronized CV if Rx doesn't work or pt becomes unstable. 2. Antidromic AVRT: wide QRS (regular) because the cardiac impulse travels antegrade through the accessory pathway and returns through the AV node. Treat with procainamide or ibutilide. Rx that slow AVN conduction are CONTRAINDICATED because it increases conduction through the accessory pathway. Synchronized CV if Rx fail or pt becomes unstable. 3. AFib with ventricular pre-excitement: wide QRS (irregular). Treat with procainamide, ibutilide, amiodarone to slow conduction from the atria -> ventricles. Synchronized CV if the patient is unstable, defibrillation may be warranted if the rate is too fast to synchronize (rates may be close to 300).

Answer 121

I would hand ventilate with 100% oxygen, deepen the anesthetic, and administer bronchodilators.

Answer 122

* 14 days after balloon angioplasty * 30 days after BMS * Optimally 6 months after DES * If P2Y12i must be d/c perioperatively, ENCS after DES implantation may be considered after 3 months if the risk of further delay is greater than the expected risk of stent thrombosis

Answer 123

* Heparin (SQ) - consider the same recommendations as IV since there can be a 10-fold variation in effect * Heparin (IV) - placement and removal should be delayed 2-4 hours after discontinuation of heparin. Heparin administration should be delayed 1 hour after placement. No need for cancellation after traumatic placement. * Heparin (systemic) - placement/removal should be delayed 2-4 hours after discontinuation of heparin. Heparin administration should be delayed 1 hour after placement. No need for cancellation after traumatic placement. * Heparin (CABG) - delay heparinization 1 hour after placement. Removal of catheter should be delayed 2-4 hours after discontinuation of heparin. Surgery delayed 12-24 hours after traumatic placement.

Answer 124

* PreOp - delay instrumentation 12h after last low-dose LMWH and 24h after last high-dose LMWH * PostOp - catheter removal 12 hours after last low-dose LMWH with dosing reinstated 2h after removal; catheter removal at least 2h prior to the first dose of high-dose LMWH * Anti-Xa monitoring not recommended as it isn't predictive of the risk of bleeding

Answer 125

1. Histamine release from rapid administration leading to venodilation, decreased SVR, reduced preload 2. Anaphylactic/anaphylactoid reaction 3. Catastrophic pulmonary HTN and RHF

Answer 126

* Dry mucous membranes * Slow capillary refill * Sunken fontanelles * Number of wet diapers * Hx of vomiting/diarrhea/poor intake from parents

Answer 127

PADSS system: score of 9 = ready for d/c 1. Vital signs - within 20% of baseline 2. Activity - steady gate w/o dizziness 3. Minimal PONV 4. Acceptable pain control per patient with PO meds 5. Minimal surgical bleeding

Answer 128

* Pneumothorax * Phrenic nerve blockade * Neuraxial injection * Intraarterial injection -> LAST and seizures * Horner's syndrome

Answer 129

* Eye opening (EYES - 4 pts max) * Verbal response (MOUTH - 5 pts max) * Motor response (MOTORS - 6 pts max)

Answer 130

• CPP 70-85 mmHg

Answer 131

* Cardiac index 2.5 - 4.5 * PCWP 2-15 mmHg * PA pressure 15-30/4-12 * MVO2 = 65-75%

Answer 132

* Vt < 6mL/kg * Static airway pressure < 30 mmHg * FiO2 < 50% * Enough PEEP to recruit small airways

Answer 133

* Potential for unDx OSA * Anatomical/physiologic abnormalities * Extent/severity of coexisting disease, and whether medical management is optimized * Nature of the surgical procedure (superficial, abd) * Intraop anesthetic requirements (local vs GA vs sedation) * Capabilities of the outpt facility to handle emergency or escalated post-op requirements * Adequacy of patient's post-discharge care * Anticipated post-op needs

Answer 134

• 3 principles of airway fire: 1. ignition source (laser), 2. Fuel (prepping agents, drapes), 3. oxidizer (O2, N2O) 1. Avoid N2O 2. Use lowest FiO2 possible 3. Use metal or laser-resistant dual cuffed ETT 4. Cuff should contain water to extinguish fire if perforated, the extra cuff will keep high-O2 concentration to the lungs 5. Consider jet ventilation or apneic oxygenation

Answer 135

* CNS symptoms before CV symptoms * Initial S/Sx include tinnitus, metallic taste, circumoral numbness, excitation/agitation ➙ seizures & respiratory arrest * Late stage includes bradycardia, ventricular arrhythmias, and cardiac arrest

Answer 136

• 3 principles of airway fire: 1. ignition source (laser), 2. Fuel (prepping agents, drapes), 3. oxidizer (O2, N2O) 1. Avoid N2O 2. Use lowest FiO2 possible 3. Use metal or laser-resistant dual cuffed ETT 4. Cuff should contain water to extinguish fire if perforated, the extra cuff will keep high-O2 concentration to the lungs 5. Consider jet ventilation or apneic oxygenation

Answer 137

• CNS symptoms before CV symptoms • Initial S/Sx include tinnitus, metallic taste, circumoral numbness, excitation/agitation ➙ seizures & respiratory arrest •

Answer 138

* Consumptive coagulopathy leading to microvascular occlusion, bleeding, and organ failure * Lab: prolonged PT & PTT, thrombocytopenia, low fibrinogen, elevated D-Dimer * Treatment of the underlying cause of the DIC is the primary goal. Transfuse pRBC, FFP, cryoprecipitate, and platelets as needed.

Answer 139

* AFE * Placental abruption * Retained products of conception

Answer 140

1. Drug-induced: droperidol, ondansetron, methadone 2. Hypokalemia and hypomagnesemia Note: PAC/PVC and R on T can lead to TdP

Answer 141

* Cardiac ischemia * Heart Failure * Hypoxia * Hypertension * Increased sympathetic activity (anxiety) * Drugs (cocaine, meth) * Electrolyte imbalances * Irritated myocardium * Re-entrant loop * Ectopic focus * Hyperthyroidism *Note PVCs can lead to VTach/Fib

Answer 142

* Pain from pancreatic, liver, splenic cancer | * Complications: diarrhea, orthostatic hypotension, LAST, paraplegia, arterial/venous injury

Answer 143

* EEG * Evoked potentials (SSEP, MEP, BEP) * EMG * Stump pressure (cerebral) * Transcranial doppler * Cerebral oximetry

Answer 144

Mild allergic: Attributed to hypersensitivity to a foreign protein in the donor product. Anaphylactic: Similar to a mild allergic reaction, however resulting in a more severe reaction. Sometimes this can occur in a patient with IgA deficiency who makes alloantibodies against IgA and then receives blood products containing IgA. Febrile non-hemolytic: Generally thought to be caused by cytokines released from blood donor leukocytes (white blood cells). Septic: Caused by bacteria or bacterial byproducts (such as endotoxin) which may contaminate blood. Acute hemolytic transfusion reactions: Can result in intravascular or extravascular hemolysis, depending on the specific etiology (cause). Immune-mediated reactions are often a result of recipient antibodies present to blood donor antigens. Non-immune reactions are possible, and occur when red blood cells are damaged before transfusion (e.g., by heat or incorrect osmotic conditions). Transfusion-associated circulatory overload (TACO): Occurs when the volume of the transfused component causes hypervolemia (volume overload). Transfusion-related acute lung injury: Acute lung injury is due to antibodies in the donor product (human leukocyte antigen or human neutrophil antigen) reacting with antigens in the recipient. The recipient’s immune system responds and causes the release of mediators that lead to pulmonary edema. Possibly contributing to this are clinical conditions that predispose the patient including infection, recent surgery, or inflammation.