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Lindsays Flashcardlet > Review Exam 1 Chapter 19 > Flashcards

Review Exam 1 Chapter 19 Flashcards

0
Q

Patients should be instructed to stop smoking ___ to ___ hours prior to surgery

A

12 to 48

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1
Q

What patients are at high risk for latex allergies

A

-Spina Bifida, urologic reconstructive surgery
-more than 9 surgical procedures
-intolerance to latex-based products
-allergy to food (avocado,buckwheat,celery,chesnut) and tropical fruits
-Intraoperative anaphylaxis of uncertain cause
Healthcare professionals esp. those with dermatitis/eczema

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2
Q

Why should patients stop smoking 12-48 hours prior to surgery?

A

Short term abstinence reduces deleterious effects of nicotine and carbon monoxide on cardiopulmonary function.

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3
Q

How long should a patient stop smoking to reduce their risk of postoperative pulmonary complications?

A

8 weeks.

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4
Q

What are anesthetic interactions with MAOIs?

A
  • Hypertension with indirect acting sympathomimetics (ephedrine)
  • Seizures or hypertensive crisis with meperidine
  • Depressive phenomena with opioid administration
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5
Q

What are anesthetic implications of tricyclic antidepressants?

A
  • Alpha blocking activity and potentiation of sympathomimetic effects of epi and norepi
  • cardiac arrhythmias
  • lower seizure threshold
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6
Q

What are the pharmacologic effects of Echinacea

A

Activation of cell-mediated immunity

-decreases effects of immunosepressives and may have immunosuppression with long term use

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7
Q

What are the pharmacologic effects of ephedra?

A

Direct and indirect sympathomimetic effects of HR and BP

  • phenylephrine is pressor of choice
  • life-threatening interactions with MAOIs
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8
Q

What are the pharmacologic effects of garlic?

A

Inhibition of platelet aggregation

-stop 7 days preop

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9
Q

What are the pharmacologic effects of ginko

A

inhibition of platelet function

-stop 36 hrs preop

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10
Q

What are the pharmacologic effects of Ginseng

A

Lowers blood glucose and inhibition of platelet aggregation

-stop 7 days preop

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11
Q

What are the pharmacologic effects of Kava?

A

sedation, anxiolysis

- increased sedative effects of anethetics

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12
Q

What are the pharmacologic effects of St. John’s Wort?

A
  • Inhibition of neurotransmitter reuptake

- Induction of cytochrome P450

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13
Q

What are the pharmacologic effects of Valerian?

A

sedation

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14
Q

What thyromental distance is associated with a difficult airway?

A

Less than 7cm (less than 3 fingerbreadths)

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15
Q

What degree of mouth opening is associated with a difficult intubation?

A

less than 4 cm

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16
Q

How do you calculate ideal body weight?

A

Male: 105 + 6 for each inch >5 ft
Female: 100 + 5 for each inch >5 ft

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17
Q

What is the calculation for BMI?

A

Weight in kg / (height in meters)²

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18
Q

What BMI is classified as overweight?

A

25 - 29.9 kg/m²

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19
Q

What BMI is associated with moderate obesity?

A

30 - 34.9 kg/m²

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20
Q

What BMI is associated with severe obesity?

A

35 - 39.9 kg/m²

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21
Q

What BMI is associated with morbid obesity?

A

greater than or equal to 40 kg/m²

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22
Q

What is the gold standard test for diagnosis obstructive sleep apnea?

A

Polysomnography

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23
Q

When is a patient taking corticosteroids considered at risk for adrenal Insufficency?

A
  • Those who receive the hydrocortisone equivalent of more than 20-30 mg daily for longer than 2 weeks
  • Those are who are receiving replacement corticosteroid treatment for adrenal insufficiency
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24
Q

What is the recommended stress dose steroid for minor surgery?

A

Preop corticosteroid dose + hydrocortisone 25mg or equivalent

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25
Q

What is the recommended stress dose steroid for moderate surgery?

A

Preoperative corticosteroid dose + hydrocortisone 50-75 mg or equivalent

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26
Q

What is the recommended stress dose steroid for major surgery?

A

Preoperative corticosteroid dose + hydrocortisone 100-15 mg or equivalent every 8 hr for 48-72 hrs

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27
Q

What should be used at hydrocortisone doses above 100 mg?

A

Methylprednisolone

4mg of methylprednisolone = 20 mg of hydrocortisone

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28
Q

Patients with a GCS off less than ____ are considered comatose and require intubation

A

8

29
Q

What is the range of scores for the glascow coma scale?

A

3-15

30
Q

What are the eye opening response scores for the GCS

A

Spontaneously - 4
To speech - 3
To pain - 2
Never - 1

31
Q

What are the best motor response scores for the GCS?

A 
Obeys commands - 6
Localizes pain - 5
Withdraws (flexion) - 4
Abnormal flexion (decortication) - 3
Extensor response (decerebration) - 2
None - 1
32
Q

What is the best verbal response score of the GCS

A 
Oriented - 5
Confused conversation - 4 
Inappropriate words - 3
Incomprehensible sounds - 2
None -1
33
Q

What does 1 MET, 4Mets and >10 METs represent?

A

1 MET - Poor functional capacity
4 MET - good functional capacity
>10 - excellent functional capacity

34
Q

What MET level is required to proceed with surgery?

A

4, provided cardiac risk factors are properly managed with statins and beta blockers.

35
Q

What is the definition of hypertension?

A

SBP >140 mmHg or a DBP >90 mmHg

36
Q

What is Class I cardiovascular disability?

A

Patients with cardiac disease with no physical limitations

37
Q

What is Class II cardiovascular disability?

A

Patients with cardiac disease who are comfortable at rest

38
Q

What is Class III cardiovascular disability?

A

Patients with cardiac disease resulting in marked limitations to physical activity

39
Q

What is Class IV cardiovascular disability?

A

Cardiac Insufficiency or anginal syndrome even at rest.

40
Q

What is the risk of reinfarction 6 months post MI, 3-6 months, and 3 months?

A

6 months: 6%
3-6 months: 15%
3 months: 30%

41
Q

What is the mortality rate of intraoperative MI?

A

50%

42
Q

When is the highest risk of reinfaction post MI?

A

30 days

43
Q

What is the recommendation time frame for elective surgery to be postponed after an MI?

A

4 - 6 weeks

44
Q

How long should elective surgery be postponed after bare metal stents (BMS) and drug eluting stents (DES)?

A

BMS - 6 weeks minimum

DES - 12 or more months

45
Q

Severe aortic stenosis poses the greatest risk when the cross sectional area is less than ____ cm²

A

1

46
Q

Dehmlow celebrity question #2:

Severe aortic stenosis is associated with a _____ greater incidence of postop sudden death.

A

14-fold

-you can thank Dehmlow for that one.

47
Q

What is the preferred method of cardiac testing?

A

Exercise stress ECG

48
Q

What three findings indicate poor ventricular function?

A
  • Cardiac index less than 2.2 L/m²
  • LVEDP greater than 18 mmHg
  • EF less than 40%
49
Q

What do areas of akinesis of myocardium represent

A
  • No movement during systole

- Nonviable regions of the myocardium

50
Q

What do areas of hypokinesis in the myocardium represent?

A
  • Reduced contraction during systole

- Ischemic but viable regions of myocardium

51
Q

What preop pharmacotherapy is appropriate for patients with up to two clinical risk factors of heart disease?

A

Statins and Beta blockers

52
Q

When should patients be started on ACE inhibitors?

A

If stable LV dysfunction is present

53
Q

In patients with COPD, when should elective surgery be cancelled?

A
  • severe dyspnea
  • wheezing
  • pulmonary congestion
  • Hypercarbia (PaCO2 >50 mmHg)
54
Q

Clinical evidence of renal Insufficiency is not apparent until ____ % of nephrons are nonfunctional

A

70

55
Q

What is the most accurate test of glomerular filtration?

A

Creatinine Clearance

56
Q

Why doesn’t BUN accurately reflect GFR?

A

Although urea is freely filtered at the glomerulus, it is reabsorbed to a large & variable extent through the tubules. BUN is also affected by amount of protein ingested by GI tract

57
Q

What is the creatinine clearance equation

A

GFR = UV/P

*U=urinary concentration of creatinine
*V=volume of urine
P=plasma concentration of creatinine

58
Q

What is the age of onset for Type 1 & 2 Diabetes?

A

Type 1: Childhood

Type2: Middle age or elderly

59
Q

Which type of diabetes has an abrupt onset and which is gradual?

A

Type 1: abrupt

Type 2: gradual

60
Q

Which type of diabetes has a higher risk of ketoacidosis?

A

Type 1

61
Q

What is Cushing’s syndrome caused by?

A

Excess levels of circulating glucocorticoid hormones.

62
Q

What are clinical manifestations of Cushing’s syndrome?

A 
Hypertension
Hypovolemia
Truncal Obesity
Buffalo Hump
Moon Face
Striae
Easy bruising
Osteoperosis
63
Q

What is hyperaldosteronism?

A

Excess of mineralocortoicoid hormones

64
Q

What are clinical manifestations of hyperaldosteronism?

A

Hypertension & Marked Hypokalemia (less than 3 mmol/L)

65
Q

Intraoperative concerns and management of ACE Inhibitors

A

Concern: Hypotension with or without bradycardia
Management: Optimize hydration, omit AM dose if possible

66
Q

Intraoperative concerns and management of calcium channel blockers

A

Concerns: Decrease SVR and BP, negative inotropy, negative chronotropy
Management: optimize hydration and phenylephrine as needed.

67
Q

Intraoperative concerns and management of Antiarrythmics

A

Concerns: Cardiac depression, prolonged NMB, hypotension, atropine resistant bradycardia

68
Q

How long should NSAIDs be held preop?

A

At least 1 day.

69
Q

How long should heparin be DC’d preop?

A

6 days

70
Q

How long should coumadin be DC’d preop?

A

3-5 days

71
Q

How long should LMWH be DC’d preop?

A

12 hrs.

Lindsays Flashcardlet (27 decks)

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