Pre-Test (Pre and Post Op, Critical Care)

Question 1

Earliest clinical indication of hypermagnesemia

Answer 1

Loss of DTR (High Mg generally leads to states of neuromuscular depression)

Question 2

Initial management of hyponatremia

Answer 2

Free water restriction

Question 3

FeNa of less than 1% in oliguric setting indicates

Answer 3

Pre-renal etiology - aggressive Na resorption in the tubules (look urine Na)

Question 4

Hypomagnesmia effects

Answer 4

paresthesia, hyperreflexia

Prlonged QT and PR intervals

Question 5

Normal EKG in pre-op pt with hx of MI

Answer 5

Still do stress test (normal EKG wouldn’t preclude further workup)

Question 6

When should mix acid-base abnormalities be suspected

Answer 6

When pH is normal, but pCO2 and Bicarb levels abnormal OR

If compensatory responses appear to be excessive

Question 7

Whenever significant bleeding is noted in early post-op period, first presumption should be

Answer 7

Error in surgical control of blood vessels in the operative field

Question 8

Goldman’s index risk #1

Answer 8

Recent MI (Up to w/in 6 mo)

Question 9

In absence of peritoneal signs, dx test of choice for acute mesenteric ischemia

Answer 9

Angiography

Question 10

Pre-op period tx for vWD

Answer 10

Desmopressin

Question 11

What do you give with PRBC

Answer 11

FFP - transfusions lead to dilutional thrombocytopenia w/ def in factors V and VII

Question 12

When do you start enteral nutrition post op

Answer 12

After bowel function if PO

If tube that passes stomach, can start w/in 24 hours

Question 13

1st step in massive bleeding from retroperitoneal hematoma in post op pt

Answer 13

Immediate reversal of Heparin w/ protamine sulfate

Question 14

What is referring syndrome? Major Complication?

Answer 14

IV glucose after chronic malnutrition leads to inc insulin levels –> electrolytes shifted back into cells
Hypophosphatemia (also hypokalemia and hypomagnesemia)

Question 15

Sepsis vs Adrenal insuff

Answer 15

Similar presentations, but sepsis generally associated with hyperglycemia and normal K+
(Adrenal insuff -> hypoglycemia and hypokalemia)

Question 16

When should FFP to replenish Vit K deep clotting factors be administered prior to OR? Why?

Answer 16

On the call to the OR

Factor 7 half-life is 4-6 hours (most stable clotting factor)

Question 17

DIC after blood products likely?

Answer 17

Transfusion reaction (hemolytic)

Question 18

What do you give a hemophilia A pt before surgery

Answer 18

Desmopressin and Aminocaproic acid (inhibitor of fibrinolysis)
FFP has F VIII but not in high enough levels to prevent bleeding in hemophiliacs

Question 19

Most common cause of Zinc def? Symptoms

Answer 19

Excessive diarrhea

Alopeica, poor wound healing, night blindness, skin rashes

Question 20

Ratio of NS or LR to replace blood loss

Answer 20

3:1 (3x fluid for 1ml blood lost)

Question 21

Fluid replacement formula per hour

Answer 21

4 ml/kg/h for first 10 kg
2 for second 10
1 for every additional kg

Question 22

Non-anion gap acidosis management

Answer 22

Fluid replacement and stool bulking agents

Question 23

Patients with large ileostomy outputs at risk for?

Answer 23

Dehydration with accompanying hyponatremia, hypokaelmia, and non-anion gap metabolic acidosis

Question 24

Hemolytic tranfusion reaction treatment

Answer 24

Fluids and mannitol

Indwelling catheter can help and diagnose by showing oliguria and hemoglobinuria

Question 25

Metabolic rate during starvation

Answer 25

Decreases by 10%

Question 26

Stress factors relative to basal metabolic rate for routine operation? multiple organ failure or severe injury? >50% burns?

Answer 26

Routine operation: 1.1 Multiple organ failure or severe injury: 1.5 >50% burns: 2

Question 27

First step if trach starts bleeding bad

Answer 27

Intubate or stop the bleeding before going to OR for median sternotomy

Question 28

Indications for extubation

Answer 28

- Rapid shallow breathing index b/w 60-105 (ratio of of RR to tidal volume) - Neg insp force >-20 - PEEP of 5 or less

Question 29

Major serious complication of hemolysis

Answer 29

Renal damage caused by precipitation of hemoglobin in renal tubules

Question 30

Anesthetic to avoid in SBO surgery

Answer 30

Nitrous oxide (more absorbable, can increase distention)

Question 31

3 major physiologic altercations of ARDs

Answer 31

1) hypoxemia unresponsive to elevations in O2 conc 2) Dec pulmonary compliance 3) Dec FRC

Question 32

3 major things that shift the O2 curve to the right

Answer 32

Acidosis, rise in PaCO2, and elevation of temperature | *Also 2,3-BPG*

Question 33

How does TRALI manifest

Answer 33

Respiratory distress, hypoxemia, and bilateral pulmonary infiltrates not due to volume overload

Question 34

Agent of choice in cardiogenic shock

Answer 34

Dobutamine

Question 35

Cardiac index formula

Answer 35

Cardiac output / Body surface area

Question 36

Tx for acalculous cholecystitis

Answer 36

Percutanous drainage of gallbladder

Question 37

Hemodynamics of septic shoc

Answer 37

Hyper dynamic state with increase in CO and decrease in peripheral vascular resistance *relatively normal central pressures*

Question 38

How does PEEP improve oxygenation

Answer 38

Increases FRC by keeping alveoli open at the end of expiration

Question 39

Tx for neurogenic shock

Answer 39

IV fluid bolus followed by presser (Phenylephrine or dopa)

Question 40

Prolonged paralysis after intubation likely from? Don't use what drug?

Answer 40

Pseudocholinesterase def | Don't use succinylcholine or Mivacurium

Question 41

3 criterion for acute transfusion reactions

Answer 41

1. Haptoglobin levels 5 | 3. + Coombs test (but takes 2-10 days)

Question 42

O2 content variables

Answer 42

Hb, O2 sat, and PaO2 (in that order for contribution)

Question 43

Highly reliable indication of alveolar ventilation

Answer 43

PcO2 (inc means not good alveolar ventilation)

Question 44

Ideal respiratory quotient

Answer 44

0.75-0.85

Question 45

What do you give pre-op pt's w/ VWD (besides desmopressin)

Answer 45

Cryoprecipitate (Has vWF and Factor VIII)

Question 46

Who is not a candidate for ECMO

Answer 46

Babies with hypoplastic lungs --> not enough surface area for gas exchange

Question 47

What is indicated for aspiration pneumonitis if there is particulate matter in tracheobronchial tree

Answer 47

Bronchoscopy

Question 48

Tx for malignant hyperthermia besides dantrolene

Answer 48

Hyperventilate with 100% O2

Question 49

Lab values for cholesterol atheroembolism

Answer 49

Eosinophilia Microscopic hematuria or proteinuria FeNa >1

Question 50

Metabolite abnormality that succinylcholine can cause

Answer 50

Hyperkalemia (worse in burn patients)

Question 51

Warfarin factors

Answer 51

II, V, VII, X, C and S

Question 52

What does thrombin time measure

Answer 52

Qualitive abnormalities in fibrinogen and presence of inhibitors to fibrin polymerization

Question 53

What can measure both amount of and nature of hypotesion

Answer 53

Pulmonary artery cath

Question 54

Measurement of HTN after CEA

Answer 54

Art line for beat to beat measurement