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Quarter 3 > Principles Exam II > Flashcards

Principles Exam II Flashcards

1
Q

Humalog

A

diabetes

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2
Q

Seroquel

A

schizophrenia

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3
Q

Strattera

A

ADHD

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4
Q

Zostavax

A

shingles vaccine

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5
Q

Chantix

A

smoking cessation aid

nicotinic receptor partial agonist

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6
Q

Evista

A

osteoporosis

also reduces risk of breast cancer

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7
Q

Combivent Respimat

A

COPD and asthma

albuterol and ipatropium inhaler

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8
Q

Avodart

A

Benign Prostatic Hypertrophy

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9
Q

Pradaxa

A

anticoagulant

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10
Q

Pristiq

A

depression

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11
Q

LoLoestrin Fe

A

birth control

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12
Q

Focalin XR

A

ADHD

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13
Q

Travatan Z

A

glaucoma

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14
Q

Lumigan

A

glaucoma

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15
Q

Vytorin

A

cholesterol

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16
Q

Toprol XL

A

beta blocker

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17
Q

Lunesta

A

sleep aid

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18
Q

Janumet

A

diabetes

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19
Q

Exforge

A

hypertension

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20
Q

Exelon

(rivastigmine)

A

Alzheimer’s

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21
Q

Humira

A

rheumatoid arthritis

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22
Q

Victoza

A

diabetes II

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23
Q

Welchol

A

diabetes

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24
Q

Combigan

A

glaucoma

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25
Q

Onglyza

A

diabetes II

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26
Q

Xoponex

A

asthma

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27
Q

Detrol LA

A

urinary incontinence

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28
Q

Enbrel

A

rheumatoid arthritis and psoriatic

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29
Q

Dulera

A

steroid and bronchodilator

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30
Q

Ranexa

A

chronic angina

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31
Q

Truvada

A

HIV

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32
Q

Avapro

A

anti-hypertensive

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33
Q

Ultram

(tramadol)

A

narcotic

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34
Q

Synthroid

A

hypothyroidism

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35
Q

Spironolactone

A

diuretic for high blood pressure

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36
Q

Protonix

A

acid reflux

proton pump inhibitor

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37
Q

Thiamine

A

vitamin B1 deficiency

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38
Q

Prochlorperazine

A

nausea and vomiting

can treat anxietyand schizophrenia

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39
Q

Tegretol

A

seizures and nerve pain

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40
Q

Amaryl

A

type II diabetes

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41
Q

Mobic

(meloxicam)

A

osteoarthritis and rheumatoid arthritis

NSAID

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42
Q

Allopurinol

A

kidney stones and gout

reduces uric acid

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43
Q

Prednisone

A

steroid for inflammation

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44
Q

Voltaren

A

NSAID

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45
Q

Ultracet

A

acetaminophen and tramadol

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46
Q

Deplin

A

B vitamin deficiency

depression

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47
Q

Dexilant

A

acid reflux

proton pump inhibitor

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48
Q

Imuran

A

immunosuppressant for arthritis

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49
Q

Bronchopleural Fistula

A

buildup of air in the pleural space

  • concern with positive pressure ventilation
    • need to use low pressures so you do not force air into that pleural space
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50
Q

Bullectomy

A

surgical removal of an air pocket in the lung

  • more commonly seen in patients with emphysema
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51
Q

Considerations for Bullectomy and volume reduction pneumoplasty

A
  • single-lung ventilation
  • avoid PEEP
  • minimize use of long-acting respiratory depressants
  • restrict administration of intravenous fluids
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52
Q

Intraoperative Complications of Bullectomy with volume reduction pneumoplasty

A
  • tension pneumothorax
  • pneumothorax
  • hypoxia
  • hypercarbia
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53
Q

Decortication

A

removal of fibrous surface layer tissue over an organ

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54
Q

Hunsaker tube

A

allows jet ventilation during bronchoscopy

  • can also measure CO2
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55
Q

Portex Adaptor

A

allows ventilation while someone is visualizing with a bronchoscope

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56
Q

Cessation of smoking for _____ weeks is associated with decreased incidence of postoperative respiratory complications

A

4 - 8 weeks

  • decreases sputum production
  • improves ciliary activity
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57
Q

Cancer Classification

A

T - cell type

N - lymph node involvement

M - metastatic spread

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58
Q

VAT

A

Video-assisted thoracoscopy

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59
Q

Pleurodesis

A

treatment for pneumothorax that stick the membranes of the lungs back together

  • talc or tetracycline
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60
Q

Unique considerations for Esophagectomy

A
  • single-lung ventilation
  • anticholinergic drug to block carotid sinus reflex
  • avoid N2O with abdominal surgery
  • increased risk for aspiration
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61
Q

Intraoperative Complications of Esophagectomy

A
  • aspiration
  • bradycardia
  • dysrhythmia
  • hemorrhage
  • hypotension
  • Hypoxia and hypercapnia
  • recurrent laryngeal nerve injury
  • tacheal tears
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62
Q

Bleomycin

A

cancer treatment

  • risk of pulmonary toxicity when given 100% oxygen
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63
Q

Doxorubicin

A

Cancer treatment

  • potential cardiac damage
  • check echocardiogram
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64
Q

LASER

A

Light Amplification by Stimulated Emission of Radiation

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65
Q

What is the most common laser?

A

CO2

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66
Q

Most common jet ventilator

A

Sanders

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67
Q

Mediastinoscopy

A

supine position and neck extended, incision through the suprasternal notch

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68
Q

Unique considerations for Mediastinoscopy

A
  • place BP cuff on left
    • avoids artifact induced by artery compression
  • place pulse ox on right hand
    • detects brachiocephalic artery compression
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69
Q

Intraoperative complications of Mediastinoscopy

A
  • air embolism
  • asthma
  • dysrhythmia
  • hemorrhage
  • neurologic event
  • perforation of esophagus
  • pneumothorax
  • respiratory compromise
  • recurrent laryngeal nerve injury
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70
Q

Ventilation during Mediastinoscopy

A

single-lumen tube

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71
Q

Tracheal malacia

A

weakening of the trachea due to compression

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72
Q

Papilledema

A

optic disc swelling that is caused by increased intracranial pressure

  • clinical finding associated with mediastonal masses
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73
Q

Cardiovascular symptoms of Mediastinal Masses

A
  • jugular distension
  • neck or facial edema
  • orthostatic hypotension
  • papilledema
  • pulsus paradoxus
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74
Q

Anesthesia for Medistonal Mass

A

preferably awake

  • spontaneous ventilation should be maintained
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75
Q

Ventilation of Medistonal Mass

A

spontaneous ventilation

  • flexible bronchoscope
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76
Q

Unique considerations for Medistonal Mass

A
  • avoid muscle relaxants
  • cardiovascular collapse
  • inability to ventilate
  • superior vena cava syndrome
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77
Q

Intraoperative complications of Medistonal Mass

A
  • bleeding
  • hypotension
  • hypoxia
  • obstruction of airway
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78
Q

Superior Vena Cava Syndrome

A

obstruction of vena cava that impedes venous flow from the head and upper extremities

  • occurs mainly in lung carcinoma patients
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79
Q

Pathophysiology of Superior Vena Cava Syndrome

A
  • decreased venous return
  • development of collateral venous circulation
  • increased peripheral venous circulation and pressure
80
Q

Cardiac features of Superior Vena Cava Syndrome

A
  • cyanosis
  • distended veins over chest wall
  • edema
  • tachycardia
  • thoracic and cervical venous distension
81
Q

thoracic outlet syndrome

A

compression of neurovascular bundle at the thoracic outlet between the 1st rib and clavicle

82
Q

Therapy for Myasthenia Gravis

A
  • anticholinesterase
  • corticosteroids
  • immunosuppressant
  • thymectomy
83
Q

Myasthenia Gravis

A

neuromuscular junction disorder causing weakness and rapid fatigue

  • antibodies attach to post-synaptic acetylcholine receptors
84
Q

2 anticholinesterases for Myasthenia Gravis

A

neostigmine or pyridostigmine

85
Q

Preoperative considerations for a Thymectomy with Myasthenia Gravis

A
  • assess respiratory function
  • evaluate strength
  • review anticholinesterase medications
86
Q

Ventilation for a Thymectomy with Myasthenia Gravis

A

usually single lumen tube

  • double lumen tube if by VAT surgery
87
Q

Unique considerations for a Thymectomy with Myasthenia Gravis

A

increased sensitivity to muscle relaxants

risk of remaining intubated

88
Q

Hemoptysis

A

coughing up blood

  • massive indicates greater than 600mL
  • mostly caused from pulmonary artery rupture from catheterization
89
Q

Causes of Massive Hemoptyis

A
  • tuberculosis
  • lung abscess
  • cystic fibrosis
  • pulmonary embolus
  • mitral stenosis
90
Q

Ventilation for Foreign Body Retrieval

A

maintain spontaneous ventilation

91
Q

Unique Considerations for Foreign Body Retrieval

A
  • respiratory status
  • sedation as tolerated
  • antisialagogue
  • precautions for “full stomach”
    • Metoclopramide
    • H2 - blocker
    • cricoid pressure
92
Q

Complications for Foreign Body Retrieval

A
  • loss of airway
  • hypoxia
  • cardiac arrest
  • aspiration
  • hemoptysis
93
Q

Zenker’s Diverticulum

A

outpouching of the pharyngeal mucosa

  • high risk of aspiration
  • risk of perforating it with ETT
94
Q

What hormone makes your feet bigger while pregnant?

A

Relaxin

95
Q

Cardiovascular changes during Pregnancy

A
  • increases cardiac output
  • SVR decreases
  • Blood volume increases 35%, mostly plasma
  • Down regulation of alpha/beta receptors
    • less responsive to vasopressors and chronotropic agents
  • Caval compression
    • decreased venous return to right atrium and therefore decreased CO
    • treat with left uterine deplacement
96
Q

Respiratory changes during Pregnancy

A
  • vascular engorgement of airway
  • Oxygen consumption increases
  • increased minute ventilation by 3-4 L/min
  • decrease in FRC
    • can only tolerate 2-3 min of hypoxia
97
Q

Hepatic changes during Pregnancy

A
  • little to no change in blood flow
  • decreased pseudocholinestersase
  • decreased colloid oncotic pressure
98
Q

Hematologic changes during Pregnancy

A
  • plasma volume increases by 45%
    • “anemia”
    • HgB < 11 g/dL is abnormal
  • hypercoagulable state
99
Q

What is the leading cause of maternal mortality?

A

thromboembolism

greatest risk for DVT and PE immediately after delivery

100
Q

Endocrine changes during pregnancy

A
  • insulin resistance
  • thyroid gland enlarges 50-70%
101
Q

Renal changes during Pregnancy

A
  • renal plasma flow and GFR increase
  • BUN and Cr decrease
102
Q

CNS changes during pregnancy

A
  • pituitary increases in size
  • brain decreases
103
Q

How does pregnancy affect MAC?

A

MAC for inhaled anesthetics is decreased up to 40% during pregnancy

104
Q

Normal fetal heart rate

A

110-160 bpm

105
Q

Term Labor

A

38-40 weeks

106
Q

EDC

A

expected date of confinement

“due date”

107
Q

EGA

A

estimated gestational age

108
Q

Risk Factors of Preterm Labor

A
  • history of preterm labor
  • infection
  • diabetes
  • hypertension
  • asthma
  • smoking, alcohol, cocaine
109
Q

Neonate

A

first 30 days out of uterus

110
Q

Indomethacin

A

prostaglandin synthetase inhibitr

  • reduces preterm labor
  • may constrict ductus arteriosus
111
Q

Tocolysis

A

drug therapy used to reduce preterm labor

uses Nifedepine and Indomethacin

112
Q

Nifedipine for tocolysis

A

CCB that relaxs the myometrium

113
Q

chorioamnionitis

A

infection that occurs within the uterus when the membranes around the amniotic fluid have broken

114
Q

Pre-eclampsia

A

abnormally high blood pressure typically during the 20th week of gestation

  • proteinuria
  • edema
  • decrease in intravascular volume
  • elevated Cr and BUN
  • elevated hemoglobin
115
Q

Eclampsia

A

pre-eclampsia with CNS involvement leading to seizures

  • severe eclampsia characterized by end-organ disease
116
Q

What do you give to reduce seizures?

A

magnesium sulfate

also diazepam and phenytoin

117
Q

Risk factors for Pre-eclampsia

A
  • asthma
  • diabetes
  • first pregnancy
  • hypertension before pregnancy
  • lupus
  • kidney disease
  • maternal age (<20 or >40)
  • multiple births
  • obesity
  • scleroderma
118
Q

Most common death due to pre-eclampsia

A

intracerebral bleeding

119
Q

(2) major causes of antepartum hemorrhage

A

placenta previa and placental abruption

120
Q

Placenta previa

A

placenta completely covers the mother’s cervix

  • must have C-section if complete previa
  • acreda, increda, and percreda
    • percreda is worse; patient will continue to bleed if any placenta is left in the uterus
121
Q

Placental abruption

A

placenta peels away from the inner wall of the uterus before delivery

122
Q

risk factors for placenta abruption

A
  • advanced maternal age
  • cocaine
  • diabetes
  • high blood pressure
  • history of
  • multiple pregnancies
  • pre-eclampsia
  • smoking
123
Q

organogenesis

A

primary organs are developing

  • first 56 days
  • most susceptible to teratogenic defects
124
Q

Drugs for uterine atony

A

Oxytocin (patosin) or Methergine

125
Q

Symptoms of local anesthetic toxicity

A
  • tinnitus
  • metalilic taste
  • circumoral numbness
126
Q

Signs of Local Anesthetic Toxicity

A
  • altered mental status
  • seizures
  • hypotension
  • bradycardia
  • ventricular arrhythmias
  • cardiovascular collapse
127
Q

Treatment for Local Anesthetic Toxicity

A

1.5 mL/kg bolus of 20% intralipid IV

then infusion at 0.25 mL/kg/min

128
Q

What do you avoid in local anesthetic toxicity

A

vasopression, CCB, BB, and local anesthetics

129
Q

Where does the spinal cord terminate?

A

conus medullaris

L1-L2 in adult

130
Q

CSF production

A

choroid plexus of the ventricles

131
Q

Contents of epidural space

A

fat, venous plexus, and segmental arteries

132
Q

Common spinal needle for cutting

A

Quincke

133
Q

pencil-point spinal needles

A

Whittacre, Sprotte, and Gertie-Marx

134
Q

gauge of typical epidural needle

A

16-20

135
Q

Most common epidural needle

A

Tuohy

136
Q

Which type of neuraxial anesthesia is used in a foot surgery?

A

spinal

sacral roots are only anesthetized with a spinal

137
Q

Intercrestal Line

A

top of the hips

around L4-L5

138
Q

Contraindications for neuraxial anesthesia

A
  • patient refusal
  • hypovolemia
  • infection at site
  • increased intercranial pressure
  • coagulopathy (platelet < 90,000)

Minor contraindications include peripheral neuropathy and sepsis

139
Q

Spinal height for upper abdominal and C-section

A

T4-T5

140
Q

Spinal height for appendectomy

A

T6-T8

141
Q

Spinal height for vaginal delivery, prostate, and hips

A

T10

142
Q

Spinal height for lower extremity surgeries

A

L2-L3

143
Q

spinal height for perineal procedures

A

S1-S2

144
Q

Where are epidurals usually placed?

A

under L2

can place one higher, but risk of spinal cord injury

145
Q

Order of tissues in spinal block

A

skin

subcutaneous tissue

supraspinous ligament

interspinous ligament

ligamentum flavum

dura

arachnoid into subarachnoid space

146
Q

Which epidural approach is better for elderly?

A

paramedian

older patients have calcification

147
Q

Hyperbaric

A

dextrose added

solution will fall

148
Q

Hypobaric

A

add sterile water

solution will rise

149
Q

Isobaric

A

add CSF or saline

150
Q

Why do pregnant women requires less local anesthetic?

A
  • progesterone changes
  • vascular engorgement
    • less space
  • shape of spinal cord
151
Q

Fentanyl in Neuraxial anesthetics

A

100 mcg - epidural

20 mcg- spinal

152
Q

Diamorphine in neuraxial anesthetics

A
  1. 5 mg - epidural
  2. 25 mg - spinal
153
Q

Epinephrine in neuraxial anesthesia

A

0.5 mg - spinal

5mcg/mL - epidural

154
Q

Test dose for epidural

A

Lidocaine (1.5%) and Epinephrine (1:200,000)

3cc

therefore, 45mg Lidocaine and 15mcg of Epi

155
Q

alkalinization of local anesthetic solutions

A

raises the pH closer to the pKa of the local anesthetic, thereby increasing the proportion in the non-ionized form

  • able to cross cell membranes
  • speed onset
156
Q

Which neuraxial procedure has a greater chance of hypotension?

A

epidural

more sympathetic response

157
Q

PMPH or PDPH

A

postmeningeal puncture headache

158
Q

Effects of spinal blocks

A

relaxes sphincters therefore higher chance of aspiration

urinary retention

159
Q

Treatment for PDPH

A

hydration, caffeine, analgesics, blood patch

160
Q

Risk factors for PDPH

A
  • younger patients
  • large needles
  • several attempts
161
Q

Transient Neurologic Symptoms (TNS)

A

pain in the butt and thighs after neuraxial anesthesia

  • using lidocaine with smaller needles
  • lasts 3-5 days
162
Q

Onset and duration of Lidocaine for Epidural Anesthesia

A

onset: moderate
duration: intermediate

163
Q

Onset and duration of Bupivacaine for Epidural Anesthesia

A

onset: slow
duration: long

164
Q

Onset and duration of Ropivacaine for Epidural Anesthesia

A

onset: slow
duration: long

165
Q

Onset and duration of 2-chloroprocaine for Epidural Anesthesia

A

onset: fast
duration: short

166
Q

Onset and duration of Tetracaine for Epidural Anesthesia

A

onset: slow
duration: long

167
Q

epidural and spinal dose of Morphine

A

epidural: 2.5 - 5 mg
spinal: 0.1-0.2 mg

168
Q

Cerclage

A

suture placed around the cervical os to prevent pregnancy loss because of an incompetent cervix

169
Q

external cephalic version

A

turn baby in uterus so it is not in breach

  • need to have C-section ready
  • may want to place epidural beforehand
170
Q

Stages of Labor

A
  1. onset or regular contractions
    1. level of anesthesia: T10-L1
  2. complete dilation to delivery
    1. lower lumbar and sacral fibers
  3. delivery of placenta
171
Q

most common local anesthetic for C-sections

A

Bupicavaine

172
Q

VBAC

A

vaginal birth after cesarean

  • increased risk of uterine rupture
173
Q

Signs and Symptoms of Transient Neurologic Syndrome (TNS)

A

pain in the lower back and buttocks

174
Q

Treatment for TNS

A
  • NSAIDS
  • opioids
  • heat
  • muscle relaxants
  • leg elevation
175
Q

Signs and Symptoms of Cauda Equina Syndrome

A
  • pain in lower back with variable motor and sensory deficits
  • radicular pain
  • sensory loss
  • bladder and bowel dysfunction
176
Q

Treatment of Cauda Equina Syndrome

A

corticosteroids

177
Q

Signs and Symptoms of Traverse Myelitis

A

pain in low back with motor weakness and sensory alterations

  • allodynia
  • bladder and bowel dysfunction
178
Q

Treatment of Traverse myelitis

A

corticosteroids

  • physiotherapy
  • exercise
179
Q

Signs and Symptoms of Anterior Spinal Artery Syndrome

A

painless loss of motor and sensory function

180
Q

Treatment for Anterior Spinal Artery Syndrome

A

correcting of hypotension and vasospasm

  • exercise
181
Q

Signs and Symptoms of Arachnoiditis

A

pain in low back with variable motor and sensory deficits

  • unilateral pain that increases with activity
182
Q

Treatment of Arachnoiditis

A
  • physiotherapy
  • steroid injections
  • electrical stimulation
183
Q

Signs and Symptoms of Epidural Hematoma

A

pain or pressure in low back with progressive motor or sensory blockade

184
Q

Treatment for epidural hematoma

A

surgical compression

185
Q

Signs and Symptoms of Epidural Abscess

A

tender pain in low back that is accompanied by sensory and motor deficits and fever

186
Q

Treatment of Epidural Abscess

A
  • antibiotics
  • percutaneous drainage
  • laminotomy with washout
  • laminectomy
187
Q

What 3 medications can increase uterine tone?

A

oxytocin, methlyergonovine, prostaglandin

188
Q

gravid hysterectomy

A

hysterectomy after birth

189
Q

What is wrong with giving magnesium to pre-eclampsia patients?

A

causes uterine atony

(muscle relaxant)

190
Q

Antenatal hemorrhage

A

bleediuring during 24+ weeks of pregnancy

  • commonly caused by placental abruption or placenta previa
191
Q

Why do pregnant women appear anemic?

A

high increase in plasma, so dilutionally they have lower hemoglobin

(10 is normal, 8 is low)

192
Q

Why do you not give 100% O2 with Bleomycin?

A

may cause pulmonary fibrosis

193
Q

Adriamycin

A

treats endometrial carcinoma and ovarian cancer

  • may cause myocardial fibrosis and CHF
194
Q

cis-Platinum

A

treatment for cervical cancer

  • may cause renal tubular dysfunction
195
Q
A

Quarter 3 (12 decks)

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