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1
Q

s/sx of hypocalcemia after parathyroidectomy

A
  1. perioral parathesias
  2. Retlessness
  3. Neuromusclar irritability (chvostek, trousseau, inspiratory stridor)
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2
Q

5 complications of RBP

A
  1. Hemorrhage
  2. Compromised ventilatory function
  3. Air embolism
  4. Damage to obturator nerve 2* retractos
  5. DVT
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3
Q

Pheochromocytoma

A
  1. Parosysmal HTN
  2. Diaphoresis
  3. Tachycarida
  4. Headache
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4
Q

What is MEN

A

Group of syndromes characterized by tumor formation in several endocrine organs

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5
Q

MEN1

A

Turmors in pancreas, pituitary gland, and parathyroid gland

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6
Q

MEN 2

A

Medulary thyroid carcinoma, pheochromocytoma, and hyperparathyroidsm or mutliple mucosal neuromas

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7
Q

Blood flow to the liver

A

70% portal vein 30 % hepatic artery

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8
Q

arterial buffer response

A

an increase in hepatic arterial flow in response to a decrease in portal blood flow 1. maintain hepatic o2 supply and 2. to maintain total hepatic blood flow, which is essential for clearance of many compounds

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9
Q

7 functions of liver

A
  1. storage and filtration of blood
  2. metabolic functions such as carbo, fat, and protein metabolism
  3. secretion of bile
  4. storage of vitamins
  5. blood coagulation
  6. storage of iron
  7. detoxification and excretion of drugs
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10
Q

Why is bile vomit usually alkaline?

A

Large amounts of alkaline phosphate are normally excreted in the bile. A three-fold or greater increase in alkaline phosphates is indicative of biliary tract obstruction

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11
Q

4 symptoms of pancreatitis

A
  1. dehydration
  2. hypocalcemia
  3. hyperglycemia
  4. ards
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12
Q

4 disease assoicated with thrombocytopenia

A
  1. chemotherapy or unrecognized cancer
  2. liver disease and splenomegaly
  3. DIC
  4. Pre-eclampsia
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13
Q

7 conditions that delay gastric emptying:

A
  1. obesity
  2. pregnancy
  3. opiods
  4. DM
  5. Trauma
  6. Pain
  7. Anxiety
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14
Q

Patients who benefit from antiemtics

A
  1. eye surgery pts
  2. GYN
  3. Obese pts
  4. History of vomiting
  5. ECSW lithotripsy
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15
Q

Droperiodol

A
  1. An antimetic (2* dopamine blockade)
  2. Produces extrapyramidal signs (2* dopamine blockade)
  3. may decrease Bp (2* weak alpha blockade)
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16
Q

treatment for droperidol induced EPS

A

Anticholinergic (benadryl or benztropine, cogentin)

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17
Q

metoclopramide:

A
  1. relaxes pyloric sphincter
  2. promotes gastric motility
  3. increase lower esophageal sphincter tone
  4. relaxes the small intestine
  5. has antiemetic actions
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18
Q

reglan is used to treat:

A
  1. diabetic gastroparesis
  2. reflux esophagitis
  3. pts at risk for aspiration pneumonitis
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19
Q

Drugs that increase gastric pH and decrease gastric volume ( H2 blockers)

A
  1. Tagamet
  2. Zantac
  3. Pepsid
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20
Q

Which drug decrease gastric volume and increase pH the most

A

ranitidine

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21
Q

4 effects of acidosis on CNS function

A
  1. depressed neuronal activity (coma)
  2. cerebral vasodilation ( increase CBF, and ICP)
  3. decrease cerebral perfusion pressure (cerebral ischemia)
  4. increase seizure threshold
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22
Q

4 causes of metabolic acidosis

A
  1. ketoacidosis
  2. lactic acidosis
  3. renal failure
  4. toxic dose of salicylates
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23
Q

plasma K increases approximately ____ for each ___ drop in pH

A

0.6 mEq/L for each 0.1 drop in pH

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24
Q

8 signs of hyponatremia

A
  1. arrhythmias
  2. hypotension
  3. pulmonary edema
  4. mental changes
  5. muscle cramps 6. weakness
  6. myoclonia
  7. edema
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25
Q

3 factors that promote hypokalemia

A
  1. alkalosis
  2. insulin
  3. beta 2 adrenergic stimulation
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26
Q

7 ways to treat hyperkalemia:

A
  1. give calcium gluconate
  2. give glucose/insulin
  3. give sodium bicarbonate
  4. give diuretics
  5. give kayexalate
  6. use HD
  7. hyperventilate
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27
Q

Plasma K is decrease ___ for each ___ mmHG decrease in PaCO@

A

0.5 mEq/L for each 10 mmgHg decrease in PaCO2

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28
Q

What should be given to the hyperkalemic pt when ventricular dysrhythmias appear?

A

calcium

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29
Q

6 physiologic function that require Ca

A
  1. action potentials in smooth and cardiac muscle
  2. blood coagulation
  3. bone formation
  4. muscle contraction
  5. membrane excitability (ca++ controls threshold)
  6. neurotransmitter release)
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30
Q

A rapid decrease in plasma CA leads to

A

skeletal muscle spasm (laryngospasm) and tetany

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31
Q

9 s/sx of hypocalcemia:

A
  1. numbness
  2. circumoral paresthesia
  3. confusion
  4. seizures
  5. hypotension
  6. increased LV filling pressure
  7. prolonged QT interval
  8. Skeletal muscle weakness
  9. Fatigue
32
Q

Contracture of facial muscle with tapping monitors seen in hypocalcemia is

A

Chvostek’s sign

33
Q

ECG changes with hypocalcemia:

A
  1. prolonged QT interval
  2. Increased ST segment duration
  3. Flat or inverted T waves
34
Q

Functions of magnesium

A
  1. functions as a cofactor in may enzyme pathways
  2. regulates the Na K pump
  3. regulates adenylate cyclase
  4. regulates slow ca channels
  5. Antagnoizes Ca
  6. controls the threshold potential
  7. regulation of the release of ach from nerve terminal
35
Q

3 s/sx of hypermag

A
  1. coma
  2. hypoventilation
  3. hypotension
36
Q

the center for ____ ___ is located in the anterior (preoptic) hypothalamus and the ___ ___ center is located in the posterior hypothalamus

A

heat loss/ heat gain

37
Q

Hypothermia is associated with:

A
  1. increase SVR and myocardial depression
  2. increase blood viscosity
  3. left shift
  4. impaired coagulation
  5. thrombocytopenia
  6. decreased drug elimination
38
Q

8 physiologic effects of hypothermia

A
  1. decrease O2 consumption
  2. increase SVR
  3. Cardiac dysth
  4. Left shift
  5. Coagulopathy
  6. Increase blood viscosity
  7. Impaired renal function
  8. decreased drug metabolism
39
Q

11 clinical manifestations of MH

A
  1. hypercarbia
  2. Tachycardia
  3. Tachypnea
  4. Hyperthermia
  5. HTN
  6. Cardiac dysrhythmias
  7. Acidosis
  8. Hyperkalemia
  9. Skeletal muscle rigidity
  10. myoglobinuria
  11. Hypoxemia
40
Q

3 stimuli for the release of renin

A
  1. decrease renal perfusion pressure
  2. hyponatremia
  3. Sympathetic NS stimulation of beta-recptors in JG apparatus
41
Q

In ketamine, dysphoria is caused by misperception and or misinterpretaion of auditory and visula stimuli by stimulating the ___ receptor, antagonizing the _____ receptor, and stimulating the ___ receptor

A

kappa, muscarinic, sigma

42
Q

4 drugs that work on GABA

A

barbs, benzo, propofol, etomidate

43
Q

CCB work in ventricular action potential? Pacemaker action potent ion?

A

Phase 2, Phase 4

44
Q

Drugs to avoid with MAOI

A

tricylic antidepressants, opiods, indirect acting sympathmomimetics fluoxetine

45
Q

5 adverse effects of mannitol

A
  1. pulmonary edema and cardiac decompenstation
  2. rebound increase ICP
  3. Hypovolemia
  4. Hyperkalemia
  5. Hyponatremia
46
Q

Why is morphine less protein bound in the neonate?

A

decrease alpha 1 acid glycoprotein

47
Q

Where do agonist- antagonist opiods work?

A

Primarily on kappa receptors and also delta receptors

48
Q

3 side effects of tricyclic antidepressants

A
  1. anticholinergic effects
  2. orthostatic hypotension
  3. sedation
49
Q

tricyclic antidepressants interact with

A
  1. anticholinergics
  2. sympathomimetics
  3. inhaled anesthics
  4. antihypertensives
  5. opiods
50
Q

5 adverse effects of mannitol administration

A
  1. pulmonary edema and cardiac decompenstation
  2. rebound increase ICP
  3. hypovolemia
  4. Hyperkalemia
  5. Hyponatremia
51
Q

Normal range for anion gap

A

9-15

52
Q

Equation for anion gap

A

Na- Cl - HCO3

53
Q

Anaphylactic reaction

A

Type 1 hypersensitivity reaction. Antibody IgE (immunoglobulin E) is produced in reponse to an antigen (foreign protein). Upon a second exposure to the antigen IgE on the surface of mast cells and basophils triggers the release of mediators including histamine. This causes bronchoconstriction, upper airway edema, vasodilation, increased capillary permeability, and uticardia.

54
Q

Anaphylactoid recations

A

Do not involve IgE. Foreign substances directly stimulate the emptying of mast cells and basophils

55
Q

TURP Syndrome and NA levels

A 
120 = restlessness and confusion
115= nasuea, somolence, ECG changes
110= seizures and coma with VT and VF
56
Q

Nonelectrolyte solutions for TURP

A

glycine, sorbitol, mannitol

57
Q

Cyanide toxicity

A

binds to cytochrome oxidase resulting in inhibition of oxidative phophorylation causing inhibition of cell respiration

58
Q

lamber-eaton syndrom

A

disorder of neuromuscular transmission associated with carcinomas. Autoimmune disease in which immunoglobin G antibodies against voltage-gated sodium channels crossreact with calcium channels at the neuromuscular junction. The result is a decreased release of ach in response to nerve stimulation. Increase sensitive to NDMR and succ is seen

59
Q

ankylosing spondylitis

A

familial disorder associated with histocompatibility antigen. Typically presents a low back pain associated with early morning stiffness in a young man. Assoicated with progressively restricted movement of the spine. Some patients develop arthritis of the hips and shoulders

60
Q

clinical features of DI

A

Polyuria > 2-15 L/day
Hypernatremia (plasma hyperosmolity)
Dilute urine (osmolality <200 mOsm/kg)

61
Q

s/sx of Di

A

polydipsia, polyuria, hypernatremia, hypovolemia, hypotension

62
Q

diagnosis of SIADH

A

deceased plasma osmolaity 100-150

63
Q

s/sx of addison’s disease

A

hypotension, hyponatremia, hyperkalemia, hypoglycemia, hemoconcentration, skin pigmentation

64
Q

s/sx cushing’s disease

A

htn, hypokalemia, hyperlgycemia

65
Q

4 reasons for difficulty breathing after thyroidectomy

A

laryngeal edema, bilateral cord paralysis, hematoma formation, hypocalcemia 2 hypoparathyroidsm

66
Q

s/sx of intraop PE

A

hypotension, tachycardia, hypoxemia, decrease SpO2, bronchospams, hypocapnia, decrease ETCO2

67
Q

3 signs of fat embolism during surgery

A

decrease ETCO2 and PaO2 and Increase PA pressure

68
Q

s/sx of acute porphyria

A

acute abdominal pain, n &v, neurotoxicity ( confusion, SIAD, difficulty swalowing, HTN, tachycardia), sensory and motor neuropathies

69
Q

6 hormones of the anterior pituitary (adenohypophysis)

A

ACTH, TSH, GH, Prolactin, LH, FSH

70
Q

S/sx of grave’s disease

A

intolerance to heat, increase sweating, mild to extreme weight loss, varying egrees of diarrhea, muscular weakness, nervousness, extreme fatigue, inability to sleep, tremor of the hand

71
Q

drug of choice for treating hyperthyroid related ventricular dysrhythmias

A

beta antagonist

72
Q

four causes of hypothyroidsm

A

subtotal lobectomy of thyroid, goiter, autoimmune disease(myxedema), radiation therapy of the thyroid

73
Q

s/sx of hypothyroidsm

A

slow mental function, slow movements, dry skin, cold intolerance, depressed ventilatory responses, abnormal cardiac conductivity, renal disease

74
Q

what regulates CA and phosphate

A

parathyroid

75
Q

parathyroid hormone increase ca by

A

increase:
absorption of ca from intestine
reabsorption of ca from renal tubule
reabsorption of ca from bone

76
Q

complications of parathyroidecotmy

A

hypocalcemia, parathesias, muscle spasm, tetany, laryngospasm, bronchospasm, apnea, hematoma, airway compromise, pneumothorax

77
Q

major postop concern after parathyroidecotmy

A

laryngospasm 2 hypocalcemia, bilateral recurrent laryngeal nerve damage, hematoma

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