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Anesthesia > PBR1 > Flashcards

PBR1 Flashcards

1
Q

TRALI blood labs

A

transient leukopenia and thrombocytopenia 2/2 pulmonary sequestration

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2
Q

EMLA drug interactions

A

lido/prilocaine (methgb) known history of sensitivity to amide LA, class I anti-arrhythmic drugs (tocainide and mexiletine) - toxic effects are additive/synergistic

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3
Q

vasopressin effects

A

cause systemic vasoconstriction via systemic V1 and cause pulmonary vasodilation via pulmonary V1

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4
Q

NO side effects

A

methgb, inhibit platelet function, inactivate surfactant, cytotoxic, immunosuppressant, mutagenesis, rebound pHTN

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5
Q

factors increasing energy expenditure

A

elective surgery, sepsis, >60% burn, long bone injuries

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6
Q

DDAVP contraindications

A

type 2b vWF disease because it increases abnormal vWF and may lead to thrombocytopenia

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7
Q

treatment of intrathecal pruritis

A

not antihistamines as histamine is not the cause of pruritis with intrathecal opioids

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8
Q

fasting requirements

A

clear fluids 2 hr, breast milk 4 hr, formula 6 hr, light meal 6 hr, heavy meal 8 hr

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9
Q

long context sensitive half life

A

thiopental > midaz, prop, etom, ketamine

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10
Q

factor XIII def labs

A

PT, PTT, TT, bleeding times all normal - diagnose with levels 1% of normal

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11
Q

vit k def

A

marked prolonged PT, prolonged PTT, normal TT and fibrinogen

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12
Q

factor VII def

A

prolonged PT, normal PTT, TT, fibrinogen

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13
Q

factor VIII and IX def

A

prolonged PTT, normal PT, TT, fibrinogen

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14
Q

CO2 absorbent CO production vs not

A

potassium/sodium hydroxide (abstracts proton from difluoromethoxy group on anesthetic) produce CO vs barium/calcium hydroxide do not

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15
Q

Blood gas partition coefficients

A 
Desflurane 0.45
Nitrous Oxide 0.47
Sevoflurane 0.65
Isoflurane 1.4
Halothane 2.5
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16
Q

Tracheobronchomalacia

A

obstructive ventilatory defect resulting in a prolonged expiratory time (a decreased FEV1) and normal FVC, resulting in a decreased FEV1/FVC

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17
Q

Examples of restrictive lung disease

A

parallel reduction in FVC and FEV1 and normal or greater than normal FEV1/FVC; examples myasthenia, PNA, kyphoscoliosis, pulmonary edema

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18
Q

post-operative respiratory failure

A

Abdominal aortic anerurysm cases > thoracic surgery, neurosurgery, upper abdominal surgery and peripheral vascular surgery

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19
Q

addisons disease symptoms

A

adrenal insufficiency - low blood pressure, salt craving, weight loss, GI problems, muscle/joint pains, hyperpigmentation, low BP

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20
Q

addisons lab abnormalities

A

hyponatremia, hyperkalemia, hyperchloremia, acidosis

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21
Q

acetazolamide

A

inhibits carbonic anhydrase - decreases sodium bicarb reabsorption, hcl is reabsorbed, potassium is wasted, water also excreted

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22
Q

addisons causes

A

autoimmune most common in US, TB is most common worldwide

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23
Q

narcs to avoid in liver failure

A

morphine, meperedine (accumulates - CNS depressive effects), alfentanil (clearance decreased); fentanyl and sufentanil ok to give

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24
Q

albumin

A

make 15g a day, half life 20 days, percentage degraded daily is 4%

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25
Q

first abnormal coag test in liver failure

A

PT - usually reflects low VII (half life 4 hr -shortest) [fibrinogen half life 4 days]

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26
Q

prerenal labs

A

urine osm >450, serum osm 280-300 (urine to plasma osm ratio >1.5, urine sodium <35%

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27
Q

uremic and bleeding

A

DDAVP - given over 15-30 min IV, improves within 1 hr and lasts 4-24 hr, tachyphylaxis after 2nd dose (2/2 to depleted endothelial stores)

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28
Q

propofol infusion syndrome

A

after 48hrs of >4mg/kg/hr; acute refractory brady leading to asystole, metabolic acidosis, rhabdomyolysis, hyperlipidemia, cardiomyopathies, skeletal myopathy, hyperkalemia

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29
Q

AFE most common symptoms

A

cardiopulmonary arrest, hypotension, fetal compromise, pulmonary edema/ARDS

30
Q

lidocaine and ECT

A

dose related decreases in duration of motor and seizure activity

31
Q

ECT EKG changes

A

tachy, ST depression, T wave inversion (parasymp - brady, asystole, PACs/PVCs)

32
Q

refeeding syndrome

A

result of hypophosphatemia 2/2 shift from fat to card metabolism -> ATP and 2,3 DPG depleted leading to impaired myocard contractility, CV collapse, resp failure, rhabdomyolysis, seizures, delirium

33
Q

botulinum A mechanism

A

inhibits release of acetylcholine from presynaptic membrane of NMJ

34
Q

IM NMBD

A

rocuronium

35
Q

sacral hiatus

A

unfused laminae S4/5

36
Q

contraindicated congenital long QT

A

amiodarone - prolongs QT interval

37
Q

congenital long QT treatment

A

flecainide, mexiletine, nicorandil, beta blockers

38
Q

FDA approved recombinant factor VII uses

A

bleeding patients with hemophilia A/B who have factor VII or IX inhibitors, patients with acquired hemophilia, patients with congenital factor VII def

39
Q

tet spell treatment

A

fluid bolus to improve RV filling and pulm blood flow, morphine, IV beta blockers, phenylephrine

40
Q

pregnancy pulmonary changes

A

FRC down 20%, Vt increase 40%, RR increase 15%, PaO2 increases 10%, VC unchanged

41
Q

surfactant production starts

A

30 weeks, 34 weeks sufficient for extrauterine life

42
Q

lowest PO2 of the body

A

coronary sinus with PO2 18-20

43
Q

hypothyroid CV changes

A

decreased HR, contractility, SV, CO (prone to overdose with more soluble volatiles from increased alveolar rate), intravascular volume (mottled extreme from vasoconstriction)

44
Q

hyperkalemia EKG progression

A

peaked T waves, wide QRS, prolonged PR, ST depression, sine wave, v fib, asystole

45
Q

adrenal insufficiency labs

A

baseline cortisol below 15 mcg/dL and increase 34 (low prob of adrenal insuff)

46
Q

H cylinders

A

6000-8000 L, high pressure system used for hospital wide gas, attached to manifold that reduces high pressure 2000 to 55, usually O2 (nitrous usually E)

47
Q

maximum current leakage in OR

A

10 microamps

48
Q

fibrillation current threshold

A

100 milliamps

49
Q

cyanide poisoning treatment

A

sodium nitrite & amyl nitrite (create methgb which combines with cyanide to make cyanomethgb - nontoxic), hydroxycobalamin/B12, sodium thiosulfate (facilitates metabolic disposal of cyanide via kidneys)

50
Q

ankylosing spondylitis ass prob

A

problem of spine, hips, shoulders, TMJ, AI, cardiac conduction abn, pleural effusions, HTN, CAD

51
Q

ankylosing spondylitis and lung

A

increased FRC and RV due to fixation of ribs in inspiratory position

52
Q

AI/MR anesthetic goals

A

relatively fast HR, increased preload, decreased afterload, maintenance of contractility and pulmonary vasc resistance

53
Q

AI treatment

A

nifedipine and ACE-I can slow progression of AR and influence LV size - improve survival (bebat blocker relatively contraindicated)

54
Q

potentiate NMB

A

magnesium, alkalosis, acidosis, hepatic dysfunction (not erythromycin)

55
Q

testes block

A

T10-L2 2/2testes descending from abdomen near origin of kidney and upper ureter

56
Q

hereditary angioedema treatment

A

C1 inhibitor concentrate is best prophylactic treatment, FFP can be given but may worsen attack, danazol used if started 5-7 days before procedure

57
Q

tumescence lido max

A

0.1% lido with 1:1,000,000 epi max is 35 mg/kg (toxic level 5 mcg/ml)

58
Q

a-a gradient

A

directly proportional to shunt, greater the shunt less likely hypoxemia will respond to increasing FiO2, indirectly proportional to MvO2, normal is <15, increases with age

59
Q

rescue median blocks

A

antecubital crease medial to biceps insertion or at wrist medial and deep to palmaris longus tendon

60
Q

radial rescue

A

AC space at lateral aspect of biceps tendon or at level of ulnar styloid between radial artery and flexor carpi radialis tendon

61
Q

ulnar rescue

A

one finger breadth proximal to the arcuate ligament or immediately lateral to flexor carpi ulnaris

62
Q

NMDA inhibitors

A

ketamine, xenon, nitrous, diethyl ether

63
Q

edrophonium

A

used to distinguish myasthenia gravis from cholinergic crisis

64
Q

omphalocele

A

failure of gut migration from yolk sac into abdomen, 40-60% have ass anom, defect lies within umbilical cord (beckwith-widemann, exostrophy of bladder, congen heart disease)

65
Q

2 most important in hospital mortality risk factors

A

chronic heart failure, unstable coronary syndrome

66
Q

loss of twitch 2,3,4

A

90%, 80%, 75% blocked

67
Q

estimated sodium deficit

A

TBW x (ideal sodium - patient’s sodium)

68
Q

which valve surgery greatest risk of complete heart block

A

AV 2/2 bundle of His adjacent to non-coronary cusp

69
Q

milrinone se

A

(inotrope, phosphodiesterase inhibitor) hypotension, atrial and ventricular arrhythmias

70
Q

contraction alkalosis management

A

potassium repletion, chloride repletion, volume repletion, acetazolamide,

71
Q

PVCs treatment

A

beta blockers are first line, amiodarone next (avoid fecainide/encainide because proarrhythmic), also lidocaine

Anesthesia (16 decks)

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