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Startprep 2 Flashcards

1
Q

Which costal cartilage is the level of the Xiphosternum?

A

7

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2
Q

Complications of CVC in neck

A
  1. carotid puncture
  2. pneumothorax
  3. hemothorax
  4. chylothorax
  5. venous thrombosis
  6. infection
  7. brachial plexus injury
  8. arrhythmias
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3
Q

external jugular vein

A
  1. sometimes used for CVC
  2. More for PIV
  3. CVC: acute angle to subclavian vein–>challenging
  4. surface of sternocleidomatorid muscle obliquely
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4
Q

blindly RIJ CVC from Sadiq

A

sternal notch–>hold medial head of SCM–>3 fingers above clavicle–>test needle–>point to nipple–> blood–>

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5
Q

MAC vs moderate sedation

A

Moderate sedation can be performed by non-anesthesiologists, but it is not called Monitored Anesthesia Care

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6
Q

What levels of sedation are part of the definition of MAC?

A

All levels

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7
Q

What factors distinguish MAC from sedation/ analgesia?

A
  1. MAC is conducted by an anesthesia provider & may include all levels of sedation
  2. Sedation can be performed by providers trained in sedation & should not include deep sedation or GA
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8
Q

Body H2O

A
  1. 60% of TBW
  2. 5% TB H2O intravascular
  3. 35% interstitial
  4. 60% intracellular
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9
Q

BNP

A
  1. brain natriuretic peptide
  2. first isolated from porcine cerebrum
  3. Not released by human brain
  4. released by ventricular myocytes in response to ventricular tension
  5. ANP= atrial natriuretic peptide
  6. ANP & BNP: antithesis of aldosterone
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10
Q

Mechanism of action of aldosterone

A
  1. upregulate Na/K pumps in distal convoluted tubule

2. insert Na channel into collecting duct

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11
Q

PG E2

A

renal ischemia protection by vasodilation

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12
Q

etomidate

A
  1. beta subunit of GABAa-R–>enhance affinity of GABA
  2. anesthetic, amnestic, NOT analgesic
  3. hemodynamic stable
    4 onset of 30 to 60 S, peak 1 min, redistribution–>3-5 min
  4. 0.2-0.4 mg/kg
  5. propylene glycol–>stinging
  6. 75% protein bound
  7. mainly eliminated via Kidney
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13
Q

indications of etomidate

A
  1. Induction of GA: sicker pt w/ hymodynamic compromise, like trauma or critical care
  2. brief hypnosis: retrobulbar block, ER procedure, cardioversion, ECT (prolong seizure)
  3. help localizing seizure foci vs terminating seizure in status epileptics
  4. No histamine release
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14
Q

effects of etomidate

A
  1. mild on respiration
  2. decrease ICP and IOP
  3. adrenocortical suppression: 5-8 hrs after single dose (inhibition of 11-beta-hydroxylase)
  4. myoclonus
  5. N/V
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15
Q

Barbiturates

A
  1. highly alkaline–>bacteriostatic
  2. anticonvulsant
  3. Methohexital: stimulate seizure
  4. GABAa receptor–>prolong
    5 induction dose: thiopental or thiamylal: 3-5mg/kg learn BW
  5. barbiturate coma
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16
Q

Barbiturates: indications

A
  1. induction of GA: thiopental 3-5 mg/kg, methohexital 1-1.5 mg/kg
  2. ICP: infusion or bolus
  3. Short procedures: Cardioversion or ECT
  4. Phenobarbital: increase glucuronyl transferase–> treat hyperbilirubinemia & kernicterus
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17
Q

Muscle relaxant vs antibiotics

A
  1. prejunctional: (-) release of Ach
  2. Postjunctional: (-) sensitivity of nAChR to Ach
  3. aminoglycoside, polymyxins, lincomycin & clindamycin: pre- & post-
  4. Tetracycline: post-
  5. cephalosporins & penicillins: safe
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18
Q

Muscle relaxant vs antiepileptic drugs

A
  1. anticonvulsants: (-) release of Ach
  2. chronic anticonvulsant–>resisentce to NDNMBs
  3. (+) sensitivity to succinylcholine
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19
Q

Muscle relaxant vs lithium

A
  1. prolongation of both NDNMBs & sux

2. decrease to dose to titrate

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20
Q

Muscle relaxant vs Mg

A
  1. pre & post junctional:
  2. decrease initial dose, titrate following dose
  3. limited to no clinical effect on succinylcholine.
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21
Q

Muscle relaxant vs volatile inhaled anesthetics

A
  1. (+) NDNMBs, but not N2O

2. desflurane > sevoflurane > isoflurane > halothane > nitrous oxide–barbiturate–opioid or propofol anesthesia

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22
Q

Drug reactions

A
  1. anaphlactoid
  2. anaphylaxis
  3. idiosyncratic
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23
Q

anaphylaxis

A
  1. type I hypersensitivity
  2. begin: w/i 5min—>2 hrs
  3. tryptase (from mast cells): sensitivity >90%, specificity just over 50%
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24
Q

mgmt. of anaphylaxis

A
  1. epi: 50-100mcg IV or 0.3-0.5mg IM; if no hypoTN–>10-20 mcg initial
  2. Short-term goals:
    Remove antigen–>FiO2=1–>airway(ET, tracheostomy or cricothyroidotomy)–>fluid for hypoTN–>titrate Epi–>vaso, noepi or neo–> (H-1 blocker: Benadryl + H2 blocker: ranitidine 50mg; hydrocortisone 1gm or methylprednisolone 125 mg; albuterol; NaHCO3; glucagon 1-5 mg if unresponsive to epi
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25
Q

ANAPHYLACTOID REACTION

A
  1. NOT mediated by IgE
  2. all other type of AB or direct drug-induced histamine release
  3. IV radiocontrast medium MCC
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26
Q

Pretreatment of anaphylacoid reaction

A
  1. Benadryl: 50 mg IV, IM, or PO 1 hr prior
  2. ephedrine
  3. corticosteroids: >12 hrs prior to contrast: prednisone 50 mg po 13, 7, 1 hr prior
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27
Q

MCC of A-a gradient

A

Shunting

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28
Q

N2O vs ventilator response to increased CO2

A

No effect

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29
Q

Promethazine

A

Promethazine is a phenothiazine and has been shown to be efficacious for treatment of nausea and vomiting at a dose of 6.25mg IV.

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30
Q

two most common types of advance directives

A

living wills and durable power of attorney for health care.

31
Q

corpus striatum of the basal ganglia

A
  1. putamen
  2. caudate nucleus
  3. nucleus accumbens
32
Q

brainstem

A
  1. midbrain
  2. pons
  3. medulla oblongata
33
Q

Ataxic respiration

A

result from lesions in the dorsomedial medulla and may be accompanied by hypersensitivity to respiratory depressants. It is considered preterminal

34
Q

Apneustic breathing

A

long, gasping inspiration with poor expiration, indicating a pontine injury

35
Q

Cluster breathing

A

irregular in frequency and amplitude with variable duration of apneic periods

36
Q

Cheyne-Stokes respirations

A
  1. hyperpnea alternating with apnea in a smooth crescendo-decrescendo pattern.
  2. bilateral injury to cortex and forebrain structures
37
Q

What are the risk factors in the Apfel risk score system?

A
  1. female
  2. nonsmoker
  3. PONV or motion sickness hx
  4. use of post-op opioids
38
Q

What is the determinant of mivacurium’s relatively short duration of action?

A

it is rapidly hydrolyzed by pseudocholinesterase.

39
Q

What are the characteristics of phase I block?

A
  1. decreased twitch amplitude
  2. sustained response to continuous (tetanic) stimulation
  3. similar decreases of all twitches in the train-of-four (ratio>0.7)
  4. absence of post-tetanic potentiation
  5. antagonism by nondepolarizing muscle relaxants
  6. augmentation by anticholinesterase drugs
40
Q

VAE

A
  1. Decreased ETCO2
  2. Increased PaCO2
  3. Increased ETN2
41
Q

Cyanide

A
  1. Sodium thiosulfate combines with unbound cyanide to form thiocyanate
    2.
42
Q

MC perioperative PNI

A

ulnar nerve injury

43
Q

neuropathies

A
  1. Neurapraxia
  2. Axonotmesis
  3. Neurotmesis
44
Q

Treatment protocol for VAE

A
  1. Notify surgeon to flood field field with NS
  2. Turn off nitrous
  3. Bil Jugular V compression
  4. Aspiration of air from CVC
  5. CV support
  6. head-down, lateral decubitus position
45
Q

How GA interferes with the eye’s natural reflexes to protect the cornea

A
  1. Mask pain perception
  2. Decreases tear production
  3. Abolishes of Bell’s phenomenon
  4. Promotes lagophthalmos
46
Q

Five signs and symptoms of PA ruptures

A
  1. hemoptysis
  2. hemothorax
  3. dyspnea
  4. anxiety
  5. hypotension
47
Q

inodilator

A
  1. milrinone
  2. other phosphodiesterase III inhibitors
  3. dobutamine (contraversal)
48
Q

which holds a greater quantity of sevoflurane, a milliliter of blood or a milliliter of gas?

A

a milliliter of blood

49
Q

Identify the physical findings in each of the four classes of the Mallampati Classification

A

I: tonsillar pillars
II: Uvula fully visible, fauces visible
III: base of uvula visible only
IV: hard palate

50
Q

Which factors may predict difficulty mask ventilation?

A
  1. Obesity: BMI>30
  2. Mallapampi: III-IV
  3. Beard
  4. Edentelous
  5. Limited Jaw extension
  6. Snoring
  7. OSA
  8. age>55 yo
51
Q

When should noninvasive cardiac testing be considered?

A

When it could change mgmt.: pts w/ poor exercise capacity & 3 clinical risk factors undergoing intermediate risk surgery or 1-2 clinical risk factors for high or intermediate risk surgery

52
Q

At what dose of succinylcholine dose the risk of phase II block occur?

A

The risk of phase II block occurs when the dose of succinylcholine exceeds 6 mg/kg IV, typically administered over an extended period of >30 mins

53
Q

What is the time of onset for symptoms of Transient Neurologic Synptoms ( TNS)?

A

12 to 24 hrs

54
Q

What is fractional saturation?

A

SaO2 = O2Hb/(O2Hb + RHb + MetHb) x 100%

55
Q

Up to what percentage of AchRs may remain occupied by a NMBD for each of the following responses?

A

75%<—DBS (no fade)

56
Q

What are the four phases of diastole?

A

Isovolumic relaxation
early filling
diastasis
atrial contraction

57
Q

how does etomidate affect the EEG?

A

Low concentration–>activated

High—>inhibited

58
Q

What is the location of superior mediastinum?

A

posterior to the manubrium sterni and anterior to bodies of first four thoracic vertebrae

59
Q

What is located in the diaphragm at T8, T10, T12?

A

T8: IVC
T10: esophageal hatus
T12: aortic hatus

60
Q

Histamine release is a consequence of which three opioids?

A

Morphine
Meperidine
Codeine

61
Q

What is the MC agent responsible for anaphylactoid reactions?

A

IV contrast agent

62
Q

What causes a leftward shift of the CO2 response curve? (Decrease ventilation for level of PCO2)

A

metabolic alkalosis, CNS depressants, denervation of the carotid body, sleep

63
Q

How do loop diuretics affect warfarin and clofibrate?

A

increase the unbound drug, increasing the free drug available

64
Q

RA should be waited how long after these meds?

A

abciximab (ReoPro): 48hrs
Ebtifibatide (Integrilin): 8 hrs
Tirofiban (Aggrastat): 8hrs

65
Q

primary effects of ACE inhibitors

A

◾decrease in Ang II formation,
◾increase in bradykinin,
◾increase in prostacyclin,
◾decrease in aldosterone and ADH production

66
Q

DDAVP (desmopressin)

A
  1. only clinically available V2 agonist

2. release von Willebrand factor and factor VIII

67
Q

At present the only clinically used vasopressin analogs

A
  1. argipressin (AVP)
  2. terlipressin (TP)
  3. desmopressin (DDAVP)
68
Q

argipressin (AVP)

A
  1. binds to all vasopressin receptor subtypes
  2. 0.04 u/min to 0.1 u/min
  3. useful in preventing and treating intraoperative hypotension in patients on ACEI and ARBs
69
Q

Methylene Blue

A
  1. inhibit NO system
  2. single 2 mg/kg IV over 20 min
  3. infusion 0.5 mg/kg
70
Q

ARBs (valsartan) or ACEI

A
  1. hypotension can be resistant to phenylephrine, epi or norepi
  2. Vasopressin infusion or low dose bolus of 0.5 - 1 unit can restore the sympathetic response
  3. withheld 24 hrs before elective surgery
71
Q

should all patients have a preoperative uninalysis?

A

No, only pts who have urinary symptoms or who are having a prosthesis implanted

72
Q

which holds a greater quantity of sevoflurance, a ml of blood or a ml of gas?

73
Q

What is the definition of a surgical emergency?

A

Am emergency exists when life, limb, sight or baby is at immediate risk w/o surgical intervention

74
Q

How do you explain the rapid recovery after a prolonged administration of propofol?

A

Propofol slowly diffuses from poorly perfused peripheral compartment into the central compartment where it is rapidly and extensively metabolized.

Anesthesia (11 decks)

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