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Pathophys II > Pathophys final review > Flashcards

Pathophys final review Flashcards

1
Q

Describe eosinophilic esophagitis.

A

reaction due to T cell mediated response that causes strictures & patient may present with difficulty swallowing
eosinophils build up in lining of esophagus

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2
Q

Extrinsic asthma is when

A

reaction is triggered by an allergen; response by IgE

intrinsic asthma is triggered by non-allergic factors such as stress, cold air, infection, & airway manipulation.

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3
Q

Treatment of acute angioedema include

A

FFP (replace the deficient enzyme)

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4
Q

A type I allergic reaction is an

A

IgE anaphylaxis reaction of mast cells & basophils

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5
Q

The epinephrine dose for anaphylaxis is

A

1-10 mcg/kg IV bolus

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6
Q

Common allergens in the OR include:

A

latex, antibiotics, & rocuronium & succinylcholine (paralytics)

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7
Q

Latex allergies present

A

in ~30 minutes (can take up to this long) because it has to cross through the skin

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8
Q

The following antibiotics are cross-reactive

A

penicillin & cephalosporin

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9
Q

Treatments for anaphylaxis include:

A

beta 2 agonists
corticosteroids
epinephrine
antihistamines

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10
Q

Can you give propofol for patients who have anaphylaxis reaction to eggs?

A

yes

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11
Q

True or false, the FDA requires all latex products to be marked.

A

True

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12
Q

How does cricoarytenoid joint arthritis affect our anesthetic and what is it?

A

cricoarytenoid joint arthritis is when the cricoarytenoid joint is malpositioned and stiff
might need to downsize our tube
can occur in rheumatoid arthritis & lupus
may present without clinical symptoms

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13
Q

Graft versus host disease may develop

A

1 month after bone marrow transplants

and conditions seen may include diarrhea, elevated liver enzymes & skin conditions

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14
Q

A HMEF filter should be used with patients who have

A

an infectious disease such as

SARS or active TB

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15
Q

Anesthetic considerations for scleroderma include

A

pHTN, difficult IV access, difficult intubation due to limited mouth opening, systemic HTN, at risk for aspiration because off hypotonia of LES, renal dysfunction

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16
Q

Lupus is an

A

autoimmune disease of T & B lymphocyte hyperreactivity

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17
Q

The four types of lupus include:

A

systemic lupus- affects the whole body, autoimmune disease
drug-induced lupus- goes away when trigger is stopped
cutaneous lupus- reactive to UV light, cutaneous changes, pigment changes, & loss of hair
neonatal lupus- from moms antibodies attacking baby- most serious result for neonates is heart block

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18
Q

Antiphospholipid syndrome is

A

acquired hypercoagulability leading to embolism
symptoms may include blood clots PE, MI, CVA
related to SLE

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19
Q

Rheumatoid arthritis is an

A

autoimmune, morning stiffness lasting more than 30 minutes

symmetrical & involves inflamed synovium

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20
Q

Describe atlantoaxial instability.

A

involves C1 & C2- need inline stabilization to prevent severance of the spinal-cord
may occur in RA

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21
Q

Sinusoids are where

A

the portal vein & hepatic artery come together to feed hepatocytes

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22
Q

If you have a clot in the celiac artery, then you have

A

poor perfusion to the hepatic artery, stomach, spleen, & pancreas

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23
Q

Arterial blood flow is dependent on

A

metabolic demand & autoregulation

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24
Q

The portal vein supplies

A

50% of the livers O2 requirement

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25
Q

Blood flow to the liver has

A

low resistance & high flow

26
Q

Kuppfer cells are responsible for

A

absorbing bacteria & cleaning the blood

27
Q

Bridging fibrosis leads to

A

decreased portal vein blood flow

28
Q

The following may decrease hepatic artery blood flow

A

alpha 1 adrenergic
beta blockers
hypotension

29
Q

When high pressure in the right atrium exists, the liver is affected because

A

it produces back pressure in the liver so it expands to 0.5 to 1 L and acts as a blood reservoir

30
Q

Pores in the sinusoids are

A

very permeable & allow easy pass of fluid & protein so lymph is similar to plasma

31
Q

Glucose is stored as

A

glycogen

32
Q

Increased hepatic vascular pressure can cause

A

fluid transudation into the abdominal cavity “liver sweating”–> ascites

33
Q

_____ is indicated in hepatic encephalopathy

A

ammonia

34
Q

Glycogen is a

A

readily available source of glucose that does not contribute to intracellular osmolality

35
Q

Phase 1 reactions include

A

oxidation & halothanation

36
Q

Phase 2 reactions include

A

glucuronidation & conjugation

37
Q

Conjugation works by

A

making products more water soluble so they can be excreted

38
Q

How does the liver store iron?

A

apoferritin + iron–> ferritin

39
Q

Describe the formation of bilirubin.

A

hemoglobin–> globin + heme–> Fe + pyrrole rings–> biliverdin–> free bilirubin–> bilirubin + albumin

40
Q

_____ bilirubin is toxic to the liver

A

Conjugated

41
Q

Obstructive jaundice can be due to

A

gallstone, malignancy or damage to hepatic cells

42
Q

Tests that measure the livers synthetic function include

A

serum albumin, PT, cholesterol, pseudocholinesterase

43
Q

The liver has a large functional reserve

A

therefore lab tests may be normal in the presence of cirrhosis

44
Q

The serum transaminase measurement reflects

A

hepatocellular integrity as opposed to liver function

- tests are not sensitive or specific

45
Q

_______ is a more specific liver function test than AST

A

alanine aminotransferase

46
Q

_______ is the NMBD of choice for patients with liver disease

A

Cisatricurium

47
Q

The most common cause of cholestasis is

A

extrahepatic obstruction & can be due to gallstones, stricture, & tumor in the bile duct
intrahepatic obstruction is from liver damage

48
Q

Mechanisms responsible for ascites include

A

portal hypertension
“sweating”
sodium retention
hypoalbuminemia

49
Q

Hepatorenal syndrome is characterized by

A 
progressive oliguria
avid Na+ retention 
azotemia
intractable ascites
high mortality
50
Q

With chronic hepatitis, the lab tests may

A

show only mild elevation of serum aminotransferases & these correlate poorly with severity of disease

51
Q

The most common cause of acute drug induced hepatitis is

A

alcohol

52
Q

In acute hepatitis, elevated _____ do not correlated well with the degree of cellular necrosis

A

transaminases

53
Q

Classify chronic persistent hepatitis, chronic lobular hepatitis, and chronic active hepatitis

A

chronic persistent hepatitis- eventually resolves and does not progress to cirrhosis; inflammation & preservation of normal cellular architecture
chronic lobular hepatitis- resolves with acute exacerbations, does not progress to cirrhosis; characterized by foci of inflammation & cellular necrosis in the lobules
chronic active hepatitis- chronic hepatic inflammation with destruction of cellular architecture; evidence of cirrhosis

54
Q

The sphincter of Oddi is affected by

A

opioids & can cause false positive cholangiograms
fentanyl is the worst offender
can give glucagon or naloxone to fix it

55
Q

The most common cause of postoperative jaundice is

A

over-production of bilirubin due to reabsorption of a large hematoma or RBC breakdown following transfusion

56
Q

Hepatic blood flow is decreased by

A

PEEP, high mean airway pressures, & hypoxemia- best if patient breathes spontaneously

57
Q

All volatile agents decrease

A

portal blood flow- greatest with halothane, least with isoflurane

58
Q

With intrahepatic or parenchymal dysfunction, we see increased

A

conjugated bilirubin, increased aminotransferases, no change in alk phosph, prolonged PT, decreased albumin

59
Q

IgE mediated type 1 hypersensitivity involve

A

mast & basophil degranulation

60
Q

_____ & ______ are not effective treatments in acute episodes of bradykinin mediated/hereditary angioedema

A

catecholamines & antihistamines

61
Q

Conjugated bilirubin is not conjugated by _____ but it is conjugated by ______ & ______

A

oxidation

glucuronide & sulfate

Pathophys II (43 decks)

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