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Anesthesia > PBR2 > Flashcards

PBR2 Flashcards

1
Q

amiloride mechanism

A

potassium sparing diuretic, directly decreases cGMP gated sodium channel activity, decreases lithium entry into tubular cells (reverse lithium-induced nephrogenic DI)

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2
Q

spironolactone/eplerenone

A

potassium sparing diuretics that competitively inhibit mineralocorticoid receptor

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3
Q

pacemaker indication

A

long QT, SA/AV node disease, reduce outflow obstruction with HOCM, treat dilated CM, mobitz type II because usually progresses to complete

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4
Q

ultrasound

A

attenuate least - water (echo lucent)

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5
Q

L5 distribution

A

lateral aspect of knee, dorsum of foot

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6
Q

dose dependent effects on SSEPs

A

barbs, propofol, volatiles, benzos, nitrous

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7
Q

leak for neonate ETT

A

15-25 cm H2O

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8
Q

type II error

A

failing to reject the null when it is actually false

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9
Q

barb use with aneurysm clipping

A

indicated when prolonged vessel occlusion is unavoidable and when EEG slowing occurs with occlusion - reduces metabolic activity (ischemic protection)

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10
Q

nitrous and CMRO2

A

increases metabolic rate, vasodilator - increases ICP

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11
Q

CBF and PaO2

A

CBF remains constant at a PaO2 greater than 50

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12
Q

Higher chance of latex allergy

A

mango, kiwi, chestnut, avocado, passion fruit, and banana

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13
Q

NMB recovery signs most reliable

A

sustained head lift for 5 seconds, sustained leg lift for 5 seconds, sustained handgrip for 5 seconds, maximum inspiratory pressure 40 to 50 cm H2O or greater

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14
Q

CCB and dantrolene

A

lethal ventricular fibrillation due to hyperkalemia in anesthetized swine

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15
Q

Garlic, ginkgo, and ginseng how long to wait

A

Garlic 7 days, ginseng 24 hours, and Ginkgo lasts 36 hours

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16
Q

rapid shallow breathing index

A

RSBI = respiratory rate/tidal volume; less than 100/105 with max FiO2 0.4

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17
Q

Phenoxybenzamine and pheo

A

Reduction in mortality is potentially reduced from 40-60% to 0-6% with the preoperative implementation of alpha-adrenergic receptor blockade, typically performed 10-14 days prior to surgery

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18
Q

Protein binding in preg

A

Maternal and fetal albumin levels are comparable; as opposed to alpha-1-acid glycoprotein which is at much higher levels in maternal plasma; bound to albumin more likely to cross placenta

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19
Q

Decreased preeclampsia risk

A

Cigarette smoking

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20
Q

LIM can detect

A

high current fow >2mA

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21
Q

most anesthesia drugs transported across placenta

A

via diffusion

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22
Q

increase intraocular pressure

A

hypercapnea, decreased PaO2, elevated CVP, succhinylcholine, some anticholinergics (IV atropine does not)

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23
Q

acquired antithrombin deficiency

A

nephrotic syndrome, cirrhosis, DIC (may have resistance to heparin)

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24
Q

pulmonary artery rupture risk

A

age >60, pHTN, hypothermia, anticoagulation, overinflation of balloon

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25
Q

compartment syndrome symptoms

A

sensory deficits before motor, manifest distal to involved compartment

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26
Q

brain dead and acetylcholine

A

lack release of endogenous acetylcholine - need to use direct agonists like isoproterenol to treat bradycardia

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27
Q

RBC salvage contraindications

A

ruptured AAA, infection, GI perforation, malignancy (can use for patient with alloantibodies which may make transfusion difficult)

28
Q

HOCM treatment

A

CCB, beta blockers

29
Q

ass with increased K after suc

A

massive trauma, encephalitis, ruptured cerebral aneurysms, metabolic acidosis & hypovolemia

30
Q

additional amiodarone se

A

thyroid dysfunction (drug has lots of iodine), peripheral neuropathy, bradyarrhythmias

31
Q

lidocaine arrhythmia use

A

useful for ventricular not supraventricular

32
Q

brain death criteria

A

coma, absent motor activity, absent brain stem, absence of ventilatory effort despite CO2 60 or 20 above baseline

33
Q

zero lumbar drain

A

phlebostatic axis at level of right atrium

34
Q

classic hemodynamics of constrictive pericarditis

A

equalization of ventricular diastolic pressure

35
Q

jet ventilation risks

A

barotrauma, pneumothorax, gastric distention, hypoxia

36
Q

R (reaction time)

A

time zero to the beginning of clot formation, signifies contributions of the intrinsic and extrinsic coagulation cascades, and the final common pathway to fibrin formation ((1-3 minutes is normal for use of Tissue Factor activator, 7-14 minutes for Celite, Kaolin)

37
Q

K (coagulation time)

A

measure of speed of clot formation and strengthening, equal to the time from amplitude 2mm to 20mm, relies on fibrinogen

38
Q

alpha angle

A

measure speed of clot formation, this relies on fibrinogen, normal is 45-55 degrees.

39
Q

MA (maximal amplitude)

A

measures maximal clot strength, equal to the max width of TEG, represents clot strength as determined by platelet number and function, as well as fibrin cross-linking to form a stable clot, normal is 50-60mm; after MA measures clot lysis

40
Q

continuous wave Doppler vs pulsed wave

A

continuous uses 2 crystals and prevents determination of maximal velocity; pulsed uses 1 crystal and high velocities are often measured as negative (aliasing)

41
Q

circumflex branch leads

A

I and aVL

42
Q

V1 uses

A

ileus, abd distention, esophageal varices, shock, Vfib/PEA

43
Q

V2 uses

A

DI and vWF def

44
Q

hypocalcemia

A

prolonged QT and ST, inverted T, bradycardia

45
Q

wall tension equation

A

= (pressure x radius)/(2 x wall thickness)

46
Q

heparin rebound after protamine

A

heparin can bind to protein which protects it from binding with protamine, when these dissociate can get rebound

47
Q

HOCM presentation

A

dyspnea, angina, dizziness, sinus tachy, double-impulse peripheral pulse, hypotension, low JVP, heart failure stigmata, murmurs (LV obstruction and MR)

48
Q

CPB and coagulation

A

platelet dysfunction common cause of post CPB bleeding - return to norm 2-4 hr post

49
Q

recombinant factor VIIa

A

binds onto tissue factor and initiates coagulation by amplifying factor IX and X leading to thrombin generation, used to decrease massive hemorrhage

50
Q

antibiotics - no NMB

A

PCN and cephalosporins

51
Q

Hering Breuer reflex

A

when pulmonary stretch receptors sense overinflation - inspiration is inhibited so expiration can occur

52
Q

high frequency ultrasound

A

poor penetration (cannot be used for deep structures)

53
Q

ultrasound attenuation

A

proportional to frequency and path length of ultrasound wave

54
Q

morphine IV:PO conversion

A

1:3

55
Q

most common postpartum foot drop

A

lumbosacral trunk damage - weakness of ankle dorsiflexion and dermatome L5 sensory loss - 2/2 head compression by pelvic brim by head

56
Q

increased potassium with suc

A

hypovolemia and metabolic acidosis, severe abd infections, closed head injury, major trauma, neuromuscular disease

57
Q

garlic discontinued

A

1 week before surgery

58
Q

valerian root discontinued

A

tapered over several weeks or will see symptoms similar to benzo withdrawal

59
Q

ginseng drug interaction

A

interferes with warfarin anticoag - may need more warfarin to achieve same results

60
Q

herbals interfere with coag

A

ginger, gingko, ginseng, garlic, saw palmetto

61
Q

kava/valerian

A

potentiate sedation

62
Q

echinacea

A

interfere with effectiveness of immunosuppressants

63
Q

st. john’s wort

A

induction of cytochrome p450, delayed emergence

64
Q

GBS treatment

A

plasmapheresis - can have hypotension and pulmonary edema, IVIG - less side effects, corticosteroids do not help

65
Q

myasthenia clue

A

disease >6 yrs, pyridostigmine >750 mg daily, preop vital capacity <3 L, pulmonary disease unrelated to myasthenia

Anesthesia (16 decks)

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