Orals

Question 0

Bradycardia

Answer 0

Primary: sick sinus, complete heart block Secondary: (vagal stim/supp) drug induced - digoxin, narcotics, anticholinesterase, beta blockers, dexmedetidine [alpha2 stim], CCB & vagal stim - oculocardiac reflex, traction on viscera, laryngoscopy, baroreceptor [carotid]

Question 1

Tachycardia

Answer 1

Primary: SVT, ventricular arrhythmia Secondary: hypoxemia, hypercapnia, decreased O2 output (anemia, low CO), pain (somatic, visceral, sympathetic), hypovolemia (absolute - dehydration, hemorrhage & relative - tamponade, pneumo, PEEP) Unusual: inotrope, pheo, carcinoid

Question 2

Hypertension

Answer 2

Primary: Long standing, associated with disease (pre-e, kidney failure) Secondary: hypoxemia, hypercapnia, decreased O2 output (anemia, low CO), pain (somatic, visceral, sympathetic), hypovolemia (absolute - dehydration, hemorrhage & relative - tamponade, pneumo, PEEP) Unusual: inotrope, pheo, carcinoid

Question 3

Hypotension

Answer 3

Preload - not enough or blocked from getting to heart (tamponade, PEEP, tension pneumo, aorto-caval compression, pinched vessel, CABG bent/twisted heart) & heart itself - muscle not strong (cardiomyopathy, MI), bradycardia/tachycardia/valvulopathy & afterload - too low (spinal shock, anaphylaxis, meds) & blood - low hematocrit and not enough to generate pressure

Question 4

Hypoxemia (1)

Answer 4

Wall to ETT: wrong gas composition, no has delivery; ETT to lungs: endobronchial/esophageal intubation, kink/clog/aspiration, disconnect, subQ tube

Question 5

Hypoxemia (2)

Answer 5

Thorax (out to in): weak chest wall from NMB, kyphoscoliosis/flail chest/phrenic nerve, pleura (fluid/air), parenchyma (aspiration, PNA, ARDS, CHF, atelectasis, V/Q mismatch), pulm vasculature (emboli), cardiac R-L shunt

Question 6

Hypercapnia

Answer 6

Making too much: MH, thyrotoxicosis, sepsis Eliminating too little: hypoventilation Rebreathing: CO2 absorber, valve, flows

Question 7

High risk procedure

Answer 7

Risk > 5% - aortic and other major vascular surgery, peripheral vascular surgery

Question 8

Intermediate risk procedure

Answer 8

Cardiac risk ~ 1-5% - intraperitoneal and intrathoracic, carotid endarterectomy, head and neck surgery

Question 9

Low risk procedure

Answer 9

Cardiac risk < 1% - endoscopic procedures, superficial procedure, cataract surgery, breast surgery, ambulatory

Question 10

Major clinical risk conditions

Answer 10

Unstable coronary syndromes, decompensated heart failure, significant arrhythmias, severe valvular disease

Question 11

Intermediate clinical risk conditions

Answer 11

h/o ischemic heart disease, h/o compensated or prior heart failure, h/o CVA, DM, renal insufficiency

Question 12

Minor clinical risk conditions

Answer 12

Abnormal EKG, rhythm other than sinus, uncontrolled systemic HTN

Question 13

CAD risk factors

Answer 13

Age, male, heredity, tobacco, cholesterol, sedentary, overweight/obese, DM, stress, alcohol, diet and nutrition

Question 14

Beta blockers and pregnancy

Answer 14

Bradycardia, hypoglycemia, respiratory depression, intrauterine growth retardation

Question 15

Rapid shallow breathing index

Answer 15

ratio of respiratory frequency to tidal volume (f/VT), <105 for extubation

Question 16

Postoperative pulmonary complications risk factors

Answer 16

Preexisting pulmonary disease, thoracic or upper abdominal surgery, smoking, obesity, age >60, prolonged GA >6 hours

Question 17

Normal FEV1 values

Answer 17

> 3L men, >2L women

Question 18

Normal FEV1/FVC percentage

Answer 18

> 70%

Question 19

Preop thoracic evaluation

Answer 19

FEV1 >800ml then postoperative FEV1 = % blood flow to remaining lung x total FEV1; FEV1 40mm Hg or PaO2 <45mm Hg means not a pneumonectomy candidate)

Question 20

High risk preop lab criteria for pneumonectomy

Answer 20

ABG (PaCO2 >45, PaO2 <10 ml/kg/min

Question 21

One lung maneuvers

Answer 21

100% O2, periodic inflation of collapsed lung, CPAP (5-10), early ligation/clamping of ipsilateral PA (pneumonectomy), position, PEEP, continuous insufflation of O2 to collapsed lung, changing tidal volume and RR

Question 22

Nitrous

Answer 22

35x more soluble than nitrogen in blood so it diffuses into air containing cavities more rapidly than nitrogen is absorbed by the bloodstream

Question 23

Hypothermia effects

Answer 23

<36 C, reduces metabolic requirements, increasing O2 consumption x5 2/2 shivering, cardiac arrhythmias an ischemia, increased peripheral vasc resistance, left shift hemoglobin-O2, reversible platelet dysfunction, postoperative protein catabolism and stress response, AMS, renal dysfunction, decreased drug metabolism, poor healing, increased infection

Question 24

Cardiac tamponade etiologies

Answer 24

Blood (postcardiotomy, chamber perforation, dissecting aortic aneurysm, trauma, anticoagulation), exudate (malignancy, infective/idiopathic pericarditis), non exudate (uremia, SLE, RA, idiopathic, radiation), air

Question 25

Tamponade pressures

Answer 25

CVP= pulmonary artery diastolic pressure = pulmonary artery occlusion pressure

Question 26

ETT mm newborn? 1 yr? 2 yr?

Answer 26

3mm, 4mm, 5mm

Question 27

ETT secure newborn? 1yr? 2 yr?

Answer 27

10cm, 11cm, 12cm (16 + age)/4

Question 28

Peds airway differences

Answer 28

Narrowest part is sub glottic

Question 29

Peds fluid

Answer 29

4:2:1; deficit - 50% 1st hour, 25% 2nd hour, 25% 3rd hour

Question 30

ROP goals

Answer 30

PO2 60-90, sat 94%