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ABA Oral Exam > Oral Boards > Flashcards

Oral Boards Flashcards

1
Q

Restrictive Lung Disease Spirometry

A

FVC DECREASED
TLC DECREASED
FRV DECREASED
FEV1/FVC NORMAL or INCREASED

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2
Q

Obstructive Disease Spirometry

A

FVC NORMAL or DECREASED
TLC NORMAL or DECREASED
FRV INCREASED
FEV1/FVC DECREASED

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3
Q

Clinically relevant aspiration pH and volume?

A
  • pH <2.5

- 25cc or more

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4
Q

What are common causes of hypoxemia?

A

decreased pulmonary capillary oxygen tension
- hypoventilation
- low FiO2
- ventilation/perfusion mismatch
- diffusion abnormality
increased shunting
- intrapulmonary or cardiac
reduced venous oxygen content
- congestive heart failure (low CO)
- increased metabolism (fever, hyperthyroid, shivering)
- decreased arterial oxygen content (anemia)

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5
Q

How long should you postpone elective surgery in a patient with asthma/COPD that has a URI?

A

airway hyperreactivity can last 2-8 weeks after infection in both healthy and asthmatics. At least 2-3 weeks is reasonable

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6
Q

Stress steroids?

A
  • used if patients treated with systemic steroids for more than 2 weeks within the previous 6 months
  • dose: 100mg hydrocortisone phosphate before induction, 100mg q8 hours x 48 hours
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7
Q

IV lidocaine dose, beneficial in airway disease?

A
  • 1mg/kg 1-2 mins prior to intubation

paradoxical bronchospasm has been documented in asthmatics

  • topical endotracheal lidocaine can work as long as patient is deep enough prior to LTA
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8
Q

What muscle relaxants cause histamine release?

A

d-tubocurarine, metcurine, succinulcholine, atracurium, mivacurium, doxcurium

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9
Q

what PaO2 should you maintain in COPD patients with supplemental oxygen?

A

PaO2 65mmHg; anything lower would increased PAP leading to right heart strain

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10
Q

Determinants of myocardial oxygen consumption

A
  • HR
  • contractility
  • myocardial wall tension
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11
Q

Myocardial oxygen supply determinant

A
  • arterial oxygen content

- coronary blood flow

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12
Q

What causes elevated Ppressure?

A
  • bronchospasm
  • anaphylaxis
  • kinking of ETT
  • mainstem intubation
  • pneumothorax
  • ARDS
  • restrictive lung disease
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13
Q

How do you perform a Bier block?

A

Double tourniquet placed on the upper arm (forearm doesn’t allow adequate arterial pressure) and inflated 100 mmHg above pts BP. 1.5-3mg/kg of 0.5% lidocaine injected into the vein and IV subsequently taken out. Tourniquet must be up for at least 30 min; at most 90 min

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14
Q

Differential diagnosis of intraoperative oliguria

A
  • kinked foley
  • hypovolemia
  • hypotension
  • decrease ADH release (2/2 stress response)
  • PPV
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15
Q

Cerebral Salt Wasting vs SIADH

Diabetes Insipidus

A

Both contain elevated urine Na and concentrated urine with decreased plasma Na

Cerebral Salt Wasting

  • HYPOVOLEMIA
  • polyuria
  • tx: saline (isotonic or hypertonic), salt tabs, limit free water intake, +/- fludorocortisone

SIADH

  • EUVOLEMIA
  • oliguria
  • plasma ADH elevated
  • tx: fluid restriction, demeclocycline, furosemide

DI:

  • HYPOVOLEMIA
  • polyuria
  • increased plasma Na concentration
  • dilute urine
  • tx: desmopressin (ADH) for central, HCTZ for nephrogenic
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16
Q

Anticoagulation stop prior to neuraxial

A

heparin: 6-8 hours with normal PTT
warfarin: 5 days and normal INR
lovenox (ppx): 12 hours
aspirin: no restrictions

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17
Q

Local Anesthetic Toxic Doses

A

lidocaine: 5mg/kg (7 mg/kg w/epi)
bupivacaine: 2.5 mg/kg
ropivacaine: 3 mg/kg

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18
Q

Mechanism of TXA

A

bind to lysine binding sites on plasminogen and fibrinogen and thereby inhibit plasminogen activator and plasmin release

inhibit fibrinolysis to prevent microvascular bleeding

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19
Q

Guidelines following ACS

A
  • balloon angioplasty: 2 weeks
  • BMS: DAPT for at least 30 d - 3 mos
  • DES: DAPT for 12 mo
  • MI: 6 mo for elective surgery
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20
Q

RCRI

A
  • elevated risk surgery
  • history of ischemic heart disease
  • history of congestive heart failure
  • history of cerebrovascular disease
  • diabetes requiring insulin
  • CKD with preop sCr >2
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21
Q

Cholinergic Crisis vs Myasthenic Crisis

A

Cholinergic: increased cholinergic activity

  • bradycardia
  • increased salivation
  • pupils constricted
  • tensilon test: symptoms exaggerated
  • symptoms improved with atropine

Myasthenic: decreased cholinergic activity/decreased receptors

  • tachycardia
  • normal secretions
  • normal pupil or dilated
  • tensilon test: symptoms relieved
  • symptoms temporarily improved with edrophonium
22
Q

Pulmonary Embolism signs and diagnosis

A

Signs/Symptoms:

  • dyspnea
  • tachypnea
  • chest pain
  • palpitations
  • low EtCO2
  • S1Q3T3

Diagnosis:

  • TTE/TEE
  • d-dimer
  • CTA PE
  • V/Q scan
23
Q

Jet Ventilation Pressure

A

pediatric: 5-10 psi
adults: 15-20 psi

increased until adequate chest excursions are noted

24
Q

RCRI criteria

A
  1. elevated surgery risk
  2. history of ischemic heart disease
  3. history of CHF
  4. history of CVA
  5. preop insulin use
  6. preop creatinine >2
25
Q

Bradycardia ACLS

A
  1. maintain airway, oxygen, IV access, EKG
  2. atropine (0.5mg), transcutaneous pacing, dopamine (2-20mcg/kg/min, epi (2-10 mcg/kg/min)
  3. consult cards, transvenous pacing
26
Q

Tachycardia ACLS

A
  • pulseless VT/VF —> SHOCK (unsynchronized)
  • synchronized DCCV: afib, aflutter, SVT
  • unsynchronized (defibrillation): pVT/VF or failure to synchronize
27
Q

Tachycardia Algorithm

A
  • maintain airway
  • if unstable, regular narrow complex (adenosine) or DCCV
  • if stable; adenosine, vagal maneuvers, CCB/BB
28
Q

Triple H Therapy

A
  • hypertension
  • hypervolemia
  • hemodilution
29
Q

Neuroprotective Mechanisms

A
  • propofol, barbiturate, etomidate gtt
  • mannitol/furosemide
  • mild hypothermia (32-34C)
30
Q

Onset, Potency and Duration of LA

A
  • onset: pKa
  • potency: lipid solubility
  • duration: protein binding
31
Q

Pyloric Stenosis Electrolyte Derangments

A
  • hypokalemia
  • hypochloremia
  • metabolic alkalosis

medical emergency, not surgical emergency. replace fluid first, then potassium (D5 1/2NS)

32
Q

Sickle Cell Disease

A
  • hemoglobinopathy leading to mutations on hemoglobin S and in presence of decreased O2 tension, deformation occurs
  • increasing hct >30% is as effective as exchange transfusion
  • avoid hypoxemia, hypotension, hypothermia, acidosis and hypovolemia
  • tx: pain control, hydration, supplemental O2, maintain hct, exchange transfusion if hgbS >40%
33
Q 
Pregnancy Changes?
CO
SVR
HR
CVP
PCWP
A

CO increases 40-50% above baseline; 80% right after birth
SVR decreases
HR increases
CVP, PCWP, PADP unchanged

34
Q

murmurs normal in pregnancy?

A
  • functional systolic murmurs occur in 90% of pregnancy

- diastolic murmurs are NEVER normal

35
Q

Hemodynamic goals in mitral stenosis

A
  • prevent tachycardia
  • prolong diastolic filling time
  • prevent AF
36
Q

Fetal Decelerations…

A
  • early: head compression
  • late: uteroplacental insufficiency
  • variable: umbilical cord compression
37
Q

vonWillebrand Disease

A
  • vWF synthesized in endothelial cells and bind to factor VIII
  • prolonged BT, aPTT and platelet function
  • treatment is DDAVP
  • NO EFFECT ON TYPES 2B AND 3
38
Q

Dantrolene MOA

A
  • binds ryanodine receptor and decreases intracellular calcium concentration
39
Q

carcinoid triad

A
  • flushing
  • diarrhea
  • cardiac involvement (pulmonic stenosis or tricuspid regurg)

symptomatic carcinoid means metastasis bypassing the liver

40
Q

postoperative jaundice

A

prehepatic: hemolysis; breakdown of hematoma, transfusion breakdown, CPB breakdown — increased bilirubin
hepatic: injury to hepatocytes; hypoxia, drug reaction, ischemia, sepsis
posthepatic: obstruction; stones, stricture, direct injury

41
Q

lowering ICP

A
  • elevate head of bed
  • avoid agitation/anxiety/coughing
  • mannitol 0.5g/kg (max 100g)
  • mild hyperventilation (no less than 30 mmHg)
  • mild hypothermia (32-33C)
42
Q

TE fistula

A
  • types A-E; most common is type C
  • avoid ventilation through fistula leading to distention of stomach
  • maintain spontaneous ventilation until corrected
  • NG decompression prior to intubation
  • catheter can be used to occlude fistula
43
Q

Malignant Hyperthermia Treatment

A
  • stop offending agents
  • initiate dantrolene 2.5mg/kg every 6 hours
  • increase fluids, may need lasix/mannitol to maintain UOP
  • serial electrolytes, blood gas, creatine kinase, LFT, coags
  • cool patient (not below 38C to prevent hypothermia)
  • monitor patient in ICU for up to 72 hours for relapse, renal function and DIC
44
Q

causes of atrial fibrillation

A
  • idiopathic
  • valvular
  • CAD
  • caffeine
  • alcohol use
  • hyperthyroidism
  • LVH
  • HTN
45
Q

how does epinephrine help in anaphylaxis?

A
  • alpha activity helps increase SVR
  • beta activity relaxes bronchial smooth muscles
  • beta increases cAMP to restore membrane permeability and decrease release of vasoactive agents
46
Q

meds to avoid in LAST

A
  • vasopressin: shown worse outcomes when used
  • CCB: negative inotropy, slowed cardiac conduction, vasodilation
  • BB: reduced blood flow to liver, negative inotropy and chronotropy
  • LA: procainamide and lidocaine
47
Q

What drugs should be avoided in a patient with pheo?

A
  • increase in fasciulations: succinylcholine
  • increase in histamine release: morphine, atracurium
  • increase in sympathetic activity: ketamine, pancuronium, atropine, ephedrine
  • droperidol, metoclopramide
48
Q

FeNa

A

< 1%: pre-renal

> 2%: ATN/intrinsic disease

49
Q

BUN/Cr

A

> 20:1 pre-renal

< 10:1 renal

50
Q

Autonomic Hyperreflexia

A
  • spinal cord lesion at T7 or higher
  • noxious stimuli below level of lesion leads to uninhibited sympathetic response
  • hypertensive leading to vasodilation and flushing above level of lesion with bradycardia
51
Q

Antiemetic Drugs

A
  • serotonin: ondansetron
  • dopamine: metaclopramide, droperidol
  • anticholinergic: scopolamine
  • glucocorticoid: dexamethasone
  • NKT antagonist: aprepitant
  • histamine: promethazine
52
Q

Effect of inhaled vs IV on ICP, CBF and CMRO2

A
  • Thiopental, propofol, and etomidate all decrease CMRO2, ICP, and CBF
  • inhaled reduce CMRO2, increase CBF

ABA Oral Exam (1 decks)

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