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943 > Test 1 > Flashcards

Test 1 Flashcards

1
Q

WHO classification of Gestational Trophoblastic Diseases (8)

** She wants us to know 4 main ones **

But who is she kidding

A
  • Choriocarcinoma **
  • Hydatiform (partial or complete) **
  • Invasive hydatiform mole **
  • Placental site trophoblastic tumor **
  • Trophoblastic lesions, miscellaneous
  • Exaggerated placental site
  • Placental site nodule and plaques
  • Unclassified trophoblastic lesion
  • *********CHIP accronym for first 4 ******
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2
Q

compare half life of meperidine to its metabolite

A
  • meperidine 2.5 - 3 hours
  • normeperidine 14 - 21 hours
    • (x3 in neonate ~ 72 hours!)
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3
Q

Risk factors for fever

A
  • nulliparity
  • prolonged rupture of membranes
  • prolonged labor
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4
Q

Issue encountered: prolonged block:

assess for what?

A
  • nerve injury
  • Epidural hematoma
    • Rule out if no back pain, unilateral block, regression of Sx
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5
Q

sensory changes (diff swallowing, breathing) are common with which opioid

A

sufentanil

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6
Q

informed consent: 3 elements must be present

A
  1. Threshold (ability to make decision)
  2. Information (risks discussed, etc)
  3. Consent (really? noo…)
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7
Q

h-2 receptor antagonists

A
  • ranitidine
  • famotidine
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8
Q

PPIs

A
  • omeprazole (Prilosec, Prilosec OTC) one she mentioned
  • lansoprazole (Prevacid, Prevacid IV, Prevacid 24-Hour)
  • pantoprazole (Protonix)
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9
Q

danger of excessive ventilation (c-section)

A
  • dec CO2 = uteroplacental vasoconstriction & Left O2 diss curve shift = fetal hypoxia
  • (I’m assumining it has to do with CO2 changes)
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10
Q

dyspnea after neuraxial usually due to

A
  • Hypotension - tx and should improve

others causes:

  • blunted thoracic proprioception
  • partial blockade of abd/intercostals
  • supine position
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11
Q

high spinal symptons

A

loss of

  • ability to talk
  • strong grips
  • maintain O2 sats
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12
Q

non-anesthetic NV causes

A
  • surgical stimulus
  • bleeding
  • medication
  • motion at end of surgery
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13
Q

single most important factor in the decline of maternal mortality from pulm aspiration during labor and csec delivery

A

use of neuraxial analgesia/anesthesia

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14
Q

shifting of uterus on stomach (where does stomach go)

A
  • shift to left & posteriorly
  • rotated to right

effects compromise of LES

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15
Q

stomach produces this much acid per day and contain this enzyme

A

1500 mL/day

pepsin

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16
Q

peak acid output

A

38 mmol/hr

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17
Q

3 phases of digestion

A
  1. cephalic - chewing, tasting, smelling (vagal stim - inc secretions)
  2. gastric - starts at release of gastrin
  3. intestinal - food goes into small int
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18
Q

prego hormone that relaxes musles and LES tone

A

progesterone

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19
Q

alveolar exudate from aspiration contatin these.

A

“R&B Cafe”

  • RBCs
  • cellular debris
  • albumin
  • fibrin
  • edema
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20
Q

most common cause of maternal anesthetic death

A

asp pneumonitis

aka: Mendelson’s syndrome

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21
Q

most common site of injury for asp pneumonia

A

RLL

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22
Q

Prophylaxis of aspirations: factors predisposing to regurgitation

A
  • OB patients (wow)
  • emergency surgery
  • difficult/fafiled intubation
  • light anesthesia
  • GERD
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23
Q

principle factors for increasing aspiration in pregnant women are:

A
  1. difficult intubation
  2. decrease LES tone
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24
Q

advantage of PPIs

A
  • long DOA
  • low toxicity
  • potential to have low maternal fetal concentrations at delivery
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25
Q

Respiratory changes:

  • FRC
  • ERV
  • Closing volume
  • O2 needs increase by
A

Respiratory changes:

  • FRC decreased by 20%
  • ERV decreased by 25%
  • Closing volume unchanged
  • O2 needs increase by 60%
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26
Q

difficult laryngeal mask ventilation defined as

A

• inability within 3 attempts of device insertion to produce expired VT > 7ml/kg (leak pressure > 15-20 cm H2O pressure)

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27
Q

During apnea, time to desaturation depends on: (3)

A

During apnea, time to desaturation depends on:

1) amount of oxygen stored in lungs, tissues, & blood

2) mixed venous oxyhemoglobin saturation

3) presence of intrapulmonary shunting

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28
Q

head ache etiology:

  • mild to moderate
  • 30 mins to 7 days duration
  • bilateral
  • nonpulsating
  • not aggrevated by physical activity
A

tension h/a

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29
Q

head ache etiology:

  • mod to severe
  • 4 - 72 hours duration
  • unilateral
  • pulsating
  • physical factors aggrevate
  • w/ nausea, photophobia, phonophobia
A

migraine

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30
Q

head ache etiology:

  • mild to mod
    • neck /shoulder pain
A

musculoskeletal

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31
Q

head ache etiology:

  • HTN and or HELLP syndrome
  • bilateral, pulsating aggrevated by physical activity
A

pre-eclampsia/eclampsia

(get ALT, AST, uric acid, plt, urine protein)

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32
Q

head ache etiology:

  • h/a w/o typical features
  • overshadowed by focal neuro signs and or altered LOC
A

subdural hematoma

(CT, MRI)

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33
Q

head ache etiology:

  • mod h/a
    • focal neuro signs and/or altered LOC
A

cerebral infarction/ischemia

(CT, MRI - “string of beads”)

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34
Q

head ache etiology:

  • progressive
  • nonpulsatile
  • aggrevated by: coughing/strain
    • inc CSF pressure
  • normal CSF chemistry
A

Idiopathic intracranial HTN

(pseudotumor cerbri/benign intracranial HTN)

(can do LP)

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35
Q

head ache etiology:

  • late h/a
  • constant
  • bilatereal or unilateral
A

carotid artery dissection

(carotid US, MRA)

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36
Q

head ache etiology:

  • no hx of dural trauma
  • diffuse
  • dull
  • worsening within 15 min of sitting/standing
  • neck stiff
  • n/v
  • tinnitis
  • photophobia
  • CSF opening pressure < 60 mm H2O in sitting position
A

spontaneous intracranial hypotension

(LP, radioisotope cisternography, CT myelography)

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37
Q

head ache etiology:

  • within 5 days of dura puncture
  • worse < 15 min of standing/sitting
  • neck stiff
  • tinnitis
  • photophobia
  • nausea
A

PDPH

(exam, possible MRI)

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38
Q

head ache etiology:

  • nonspecific ha
  • postural component
  • focal neuro signs
  • seizures
A

cortical vein thrombosis

(CT or MRI/A)

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39
Q

head ache etiology:

  • rapid
  • intense
  • incapacitating
  • unilateral
  • nausea
  • nuchal rigidity
  • altere LOC
A

SAH

(CT w/ contrast or MRI FLAIR sequence)

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40
Q

head ache etiology:

  • severe
  • diffuse
  • acute or gradual onset
  • possible focal sz/neuro deficits
A

posterior reversible (leuko) encephalopathy syndrome (PRES)

(MRI)

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41
Q

head ache etiology:

  • progressive
  • localized ha
  • worse in morning
  • aggravated by couging/strain
A

brain tumor

(CT, MRI)

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42
Q

head ache etiology:

  • frontal h/a
    • facial pain
  • h/a + nasal obstruction
  • purulent nasal discharge, anosmia and fever
A

sinusitis

(CT, MRI, nasal endoscopy)

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43
Q

head ache etiology:

  • most frequent symptom
  • diffuse
  • intensity inc with time
    • nausea, photophobia, malaise, fever
A

Meningitis

(LP)

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44
Q

head ache etiology:

  • mild to mod
  • temporal w/ breast-feeding or breast engorgement
A

lactation h/a

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45
Q

head ache etiology:

  • mild to mod
  • assoc w/ zofran intake
A

ondasetron h/a

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46
Q

PDPH must include one the following sx (5)

A
  • Diagnosis must include one of the following: May include:
    • neck stiffness
    • tinnitus
    • hypacusis (hearing disturbance)
    • photophobia
    • nausea
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47
Q

complications of PDPH

A
  • immediate issues (ER, extended hostitalization, cant do ADLs)
  • subdural hematoma
  • dural sinus thrombosis
  • diplopia or hearing loss
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48
Q

Best Treatment for PDPH

and other tx’s

A
  • Best Treatment for PDPH is PREVENTION
    • Posture: bedrest does not help to prevent: recommendation is to still have patients ambulate early
    • Hydration: Little evidence to support
    • Caffeine: No evidence to support
    • Cosyntropin: one study showed significantly fewer PDPH; mechanism unknown
    • Neuraxial opioids: 1 study showed reduction with epidural opioids; caution against routine use
    • Intrathecal catheters: most studies do no find significant decrease in PDPH
    • Prophylactic epidural/intrathecal saline to increase CSF: needs further study
    • Prophylactic blood patch: reliable conclusions cannot be made
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49
Q
  • Blood patch Contraindications: (4)
A
  • Blood patch Contraindications:
    • known coagulopathy
    • local cutaneous or untreated systemic infection
    • increased ICP due to space-occupying lesion
    • patient refusal
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50
Q

Hip innervation

  • flexion
  • extension
  • aBduction
  • adduction
  • medial rotation
  • lateral rotation
A

Hip innervation

  • flexion L1-3 (L4 min)
  • extension L4-S2
  • aBduction L5-S1
  • adduction L2-4
  • medial rotation L1-S1
  • lateral rotation L5-S2
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51
Q

Knee innervation

  • flexion
  • extension
A

Knee innervation

  • flexion L5-S2 (min L2-4)
  • extension L2-L4
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52
Q

Ankle innervation

  • dosriflexion
  • plantar flexion
A

Ankle innervation

  • dosriflexion L4-L5
  • plantar flexion S1-S2
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53
Q

Big toe dorsiflexion innervation

A

L4-S1

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54
Q

Levator ani innvervation

A

S2-S4

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55
Q

Coccygeus innervation

A

S4

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56
Q

which nerve injury

  • By fetal head at pelvic brim often due to cephalopelvic disproportion (**Usually occurs with prolonged labor or difficult vaginal delivery)
  • Affects peroneal nerve most often Medial Nerve Fibers that form Peroneal Nerve
  • Weak ankle dorsiflexion (foot drop);
  • Sensory involves L5 dermatome
A

Compression of lumbosacral trunk

  • By fetal head at pelvic brim often due to cephalopelvic disproportion (**Usually occurs with prolonged labor or difficult vaginal delivery)
  • Affects peroneal nerve most often Medial Nerve Fibers that form Peroneal Nerve
  • Weak ankle dorsiflexion (foot drop);
  • Sensory involves L5 dermatome
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57
Q

which nerve injury

  • Susceptible as it crosses brim of pelvis or in obturator canal
  • Mother often experiences pain when damage occurs
  • Weakness of hip adduction & internal rotation
  • Sensory disturbance over thigh

Can happen with both c-section and vaginal deliveries

A

Obturator Nerve Palsy

  • Susceptible as it crosses brim of pelvis or in obturator canal
  • Mother often experiences pain when damage occurs
  • Weakness of hip adduction & internal rotation
  • Sensory disturbance over thigh

Can happen with both c-section and vaginal deliveries

58
Q

which nerve injury

  • Vulnerable to stretch injury as it passes beneath inguinal ligament
  • Due to prolonged flexion, abduction, & external rotation of hips in 2nd stage labor
  • Procedures conducted in excessive lithotomy position
  • Patellar reflex diminished or absent

Pts may walk satisfactory on level surface but have difficulty climbing stairs

A

Femoral nerve palsy

  • Vulnerable to stretch injury as it passes beneath inguinal ligament
  • Due to prolonged flexion, abduction, & external rotation of hips in 2nd stage labor
  • Procedures conducted in excessive lithotomy position
  • Patellar reflex diminished or absent

Pts may walk satisfactory on level surface but have difficulty climbing stairs

59
Q

which nerve injury

  • Neuropathy of the lateral femoral cutaneous nerve (purely sensory)
  • Most likely cause: entrapment of nerve as it runs around the anterior superior iliac spine as it passes through inguinal ligament
  • Risk factors:
    • abdominal mass
    • retractors for pelvic surgery
    • edema
    • extremely large uterus such as twins or triplets
  • Sx: numbness, tingling, burning, etc., of anterolateral thigh

Condition is expected to resolve after delivery

A

Meralgia Paresthetica

  • Neuropathy of the lateral femoral cutaneous nerve (purely sensory)
  • Most likely cause: entrapment of nerve as it runs around the anterior superior iliac spine as it passes through inguinal ligament
  • Risk factors:
    • abdominal mass
    • retractors for pelvic surgery
    • edema
    • extremely large uterus such as twins or triplets
  • Sx: numbness, tingling, burning, etc., of anterolateral thigh

Condition is expected to resolve after delivery

60
Q

Significant causative factors of PP bladder dysfunction:

A

Significant causative factors of PP bladder dysfunction:

  • Prolonged 2nd stage of labor
  • Instrumental delivery
  • Perineal damage
61
Q

Space occupying lesions: Deficit depends on vertebral level location:

a. lower thoracic
b. lumbar

A

SOL: Deficit depends on vertebral level location:

  1. Low thoracic -> leg weakness or paraplegia;
  2. Lumbar -> cauda equina syndrome; back pain radiating to legs is common
62
Q
  • Meningitis: Causative organism:
A
  1. Meningitis
    1. Causative organism:
      1. Neisseria meningitidis
      2. Streptococcus pneumoniae
      3. Haemophilus influenzae
      4. also reported tuberculosis
      5. viruses
      6. -hemolytic strep
63
Q

Meningitis Risk factors:

A
  1. Meningitis Risk factors:
    1. dural puncture
    2. labor
    3. infection at a remote site
    4. faulty technique
64
Q

RIsk factors for chemical damage to the Cauda Equina

A
  • Poor spread of local
    • block failure then repeated injections made
    • fine gauge needle or pencil-point
    • microspinal catheter
    • continuous infusion
    • hyperbaric soln
    • lithotomy
  • unintentional intrathecal inj with large epidural dose
  • incorrect formulation with unsuitable preservative/antioxidant
  • intrathecal inj of LIDOCAINE 5% (also tetracaine or dibucaine?)
65
Q
  1. Lawsuits against health care providers are primarily filed due to a lack of failure.
    1. Failures include: (4)
A
  1. Lawsuits against health care providers are primarily filed due to a lack of failure.
    1. Failures include:
      1. Lack of informed consent
      2. Poor patient rapport
      3. Language barriers
      4. Inadequate discharge instructions
66
Q
  1. Theories of Liability
    1. Patients may sue for injuries resulting from provision of health care using 1 or more of 3 different theories
A
  1. Theories of Liability
    1. Patients may sue for injuries resulting from provision of health care using 1 or more of 3 different theories
      • medical malpractice
      • breach of contractual promise that injury would not occur
      • lack of informed consent
67
Q
  • defined as “that degree of care, skill, & learning expected of a reasonably prudent health care provider at that time in the profession or class to which he/she belongs …acting on the same or similar circumstances”.
A

Standard of care

68
Q

Establishing medical malpractice: 4 elements required

A
  • Establishing medical malpractice: 4 elements required
    • Duty
      • Duty to provide care
    • Breach
      • Failed to meet duty to provide reasonable care
    • Injury
    • Proximate cause
      • Negligence of provider proximately causing the injury
69
Q

Doctrine of res ipsa loquitur (means what??): and.. 3 conditions

A

Doctrine of res ipsa loquitur (the thing speaks for itself): 3 conditions

1) injury ordinarily does not occur in absence of negligence
2) injury caused by agency or instrumentality in exclusive control of defendant
3) injury not a result of any voluntary action or contribution on part of the plaintiff

70
Q
  • Lack of informed consent: (also cause for lawsuit)
  • Pt must prove:(4)
A

Lack of informed consent: (also cause for lawsuit)

Pt must prove:

1) existence of material & foreseeable risk unknown to patient

2) failure to inform plaintiff of that risk

3) disclosure of risk would have led to rejection of difference course of treatment

4) causal connection between failure to inform & injury resulting from occurrence of nondisclosed risk

71
Q

systemic diseases (autoimmune)

A

Systemic Autoimmune

*if not on this list probably an ‘organ-specific’ autoimmune

  • SLE
  • RA
  • MS
  • Sjogren’s
  • Dermatomyosis
  • scleroderma
  • polymyositis
  • mixed connective tissue disease
  • Wegener’s granulomatosis
72
Q
  • Dx criteria for SLE (need at least 4)
    • 20% of SLE occurs during pregnancy
A
  • Malar rash (butterfly over malar region)
  • discoid rash (red, raised patches with scaling)
  • photosensitive
  • oral ulcers
  • arthritis
  • serositis (pleuritis/pericarditis)
  • renal issues (protein/casts)
  • neuro (sz, psychosis)
  • hematologic (anemia, leukopenia, lypmphopenia, thrombocytopenia)
  • immunogenic (anti-DNA, anti-Sm nuclear antigen, anticardiolipin, anticoagulant, false positive syphilis)
  • antinuclear antibody
73
Q

10 warning signs of LUPUS FLARE

A
  1. aching, inc joint swell
  2. weakness/pain in muscle
  3. unusual high/frequent fever
  4. inc fatigue/exhaustion
  5. hair loss
  6. h/a
  7. dizzy/forgetful
  8. abd pain/digestive issues
  9. rash
  10. new/unexplained symptom
74
Q

Antiphospholipid Syndrome (APS) or Hughes Syndrome

  • Prothrombotic disorder characterized by presence of 2 autoantibodies:
A

Antiphospholipid Syndrome (APS) or Hughes Syndrome

  • Prothrombotic disorder characterized by presence of 2 autoantibodies:
    • Lupus anticoagulant
    • anticardiolipin antibody
75
Q

Describing which autoimmune dz?

  • Chronic, progressive autoimmune disease of unknown etiology
  • Characterized by:
    • deposition of fibrous connective tissues in skin & other tissues,
    • microvascular changes
    • chronic inflammation
  • Limited or Diffuse process
A

Scleroderma

  • Chronic, progressive autoimmune disease of unknown etiology
  • Characterized by deposition of fibrous connective tissues in skin & other tissues, microvascular changes, & chronic inflammation
  • Limited or Diffuse process
76
Q

Describes which autoimmune dz?

  • Members of the disease group, idiopathic inflammatory myopathic disease
  • characterized by nonsuppurative inflammation of muscle, primarily skeletal muscles of proximal limbs, neck, & pharynx
    • Inflammation leads to symmetric weakness, atrophy, & fibrosis of affected muscles
  • Can have heliotrope eruptions (blue-purple discoloration of upper eyelid) & Gottron’s papules (raised scaly, violet eruptions over knuckles)
  • woman 2x > men
A

Polymyositis & dermatomyositis

  • Members of the disease group, idiopathic inflammatory myopathic disease
  • Polymyositis: characterized by nonsuppurative inflammation of muscle, primarily skeletal muscles of proximal limbs, neck, & pharynx
    • Suppurative means the formation of pus.
    • Inflammation leads to symmetric weakness, atrophy, & fibrosis of affected muscles
  • Dermatomyositis: same disorder with addition of heliotrope eruption (blue-purple discoloration of upper eyelid) & Gottron’s papules (raised scaly, violet eruptions over knuckles)
  • woman 2x > men
77
Q
  • Conditions predisposing women to aortic dissection during pregnancy
A
  • Conditions predisposing women to aortic dissection during pregnancy
    • Marfan syndrome
    • Ehlers-Danlos syndrome
    • bicuspid aortic valve
    • Turner syndrome
    • non-Marfan syndrome-associated familial thoracic aneurysms
78
Q

Which cardio dz:

  • autosomal dominant
  • causes aortic dilation and dissection
  • presence of valvular disease
A

Marfan

79
Q

Which cardio dz:

  • connective tissue dz
  • TYPE 1,2,3 (explain)
  • TYPE 4 (explain)
A
  • Ehlers-Danlos – Connective tissue disease with varying degrees of severity
    • Types 1, 2, & 3 have more pelvic instability, preterm delivery, perineal lacerations, and post-partum hemorrhage
    • Type 4 at risk of rupture of bowel, aorta, vena cava and uterus
80
Q
  • complete of partial absence of an X chromosome
  • assoc. with aortic coarctation and HTN
  • 30% will have a bicuspid aortic valve which is a risk for aortic dissection
A

Turner’s Syndrome – complete of partial absence of an X chromosome, assoc. with aortic coarctation and HTN, 30% will have a bicuspid aortic valve which is a risk for aortic dissection

81
Q

name of condition in Marfan with widening of the dural sac usually in the lumbar sacral area - complicates neuraxial

A

Dural ectasia

(scoliosis complicates neuraxial in marfans too)

82
Q

Transposition of the great arteries

  • Divided into these two groups:
A

Transposition of the great arteries

  • Those with transposition of the great arteries are divided into two groups:
  • D-Transposition: Complete transposition of the great arteries
  • L-Transposition: Congenitally corrected transposition of the great arteries
83
Q

pulm HTN anesthetic considerations

A

pulm HTN anesthetic considerations

(VERY high risk group)

  • maintain SVR
  • maintain PRELOAD
  • Prevent/Tx
    • pain
    • acidosis, hypoxemia, hypercarbia
  • avoid myocardial depression
  • PA cath with fluoro better
84
Q
  • Primary goals of anesthesia in Eisenmenger Syndrome (5)
A

Primary goals of anesthesia:

  • 1) maintain adequate SVR
  • 2) Maintain adequate intravascular volume & venous return
  • 3) avoid ACC
  • 4) prevention of pain, hypoxemia, hypercarbia, & acidosis (↑ PVR)
  • 5) avoidance of myocardial depression
85
Q
  • Most common cause of Aortic Stenosis in pregnant women is:
  • Other less common causes:
A
  • Most common cause of Aortic Stenosis in pregnant women is congenital bicuspid aortic valve
  • Other less common causes:
    • Rheumatic
    • supravalvular AS
    • subvalvular AS
86
Q

type of AS that is unlikely in pregnancies

A

Caclific AS

  • occur much later in life post childbearing
87
Q

preferred delivery method in AS

A

vaginal

88
Q

Aortic Stenosis

  • Anesthetic Goals:
A

Aortic Stenosis

Anesthetic Goals:

  • 1) maintain normal HR, NSR, and adequate SVR
  • 2) maintain intravascular volume & venous return
  • 3) avoidance of aortocaval compression
  • 4) avoid myocardial depression during GA
89
Q

gold standard anesethetic for severe AS

A

GA

90
Q

Most common cause of AR

A

degenerated bicuspid aortic valve

91
Q

most common cause of aucte AR

A

endocarditis

92
Q

Goals of anesthetic management in AR

A
  • Goals of anesthetic management in AR:
    • 1) maintenance of normal to slightly elevated HR
    • 2) prevention of an increase in SVR
    • 3) avoidance of aortocaval compression
    • 4) avoidance of myocardial depression during general anesthesia
93
Q

Most commonly valvular disease in pregnancy

A

MS

94
Q

MS: why is vaginal delivery assisted

A

avoids valsalva in 2nd stage bc may increase CVP

95
Q

Anesthetic goals for Mitral Stenosis:

A
  • Anesthetic goals for Mitral Stenosis:
    • 1) maintenance of low-normal HR & preserve NSR
    • 2) aggressive treatment of atrial fibrillation, if present
    • 3) avoid aortocaval compression
    • 4) maintenance of venous return
    • 5) maintenance of adequate SVR
    • 6) prevention of pain, hypoxemia, hypercarbia, & acidosis (can PVR)
96
Q

DM: insulin resistance due to presumed mechanisms of inc counterregulatory hormones (4)

A

DM: insulin resistance due to presumed mechanisms of inc counterregulatory hormones (4)

  • placental lactogen
  • placental growth hormone
  • cortisol
  • progesterone
97
Q

pre-gestational DM and insulin resistance

A

insulin requirements increase during pregnancy bc of increase in peripheral insulin resitance that already existed

(so.. additive resistance when during pregnancy state)

98
Q

DM-1 insulin requirements during stages of labor 1 and 2

A
  • Insulin requirements decrease with the onset of the 1st stage of labor
  • Insulin requirements increase during 2nd stage of labor
99
Q
  • Both pregestational & gestational DM associated with higher rates of (3)
A
  • Both pregestational & gestational DM associated with higher rates of
    • gestational HTN
    • polyhydramnios
    • cesarean delivery
100
Q

DM: fetal acidosis not likely if: (3)

A

DM: fetal acidosis

  • Not likely if:
    • 1) satisfactory maternal glycemic control;
    • 2) preanesthetic volume expansion with non-dextrose balanced salt solutions
    • 3) maintain hemodynamic stability
101
Q

peripartum glucose level goal

A

70 - 90 mg/dL

102
Q

may be the most significant sign for potential of diabetic stiff-joint syndrome leading to a difficult airway/intubation

A

Prayers Sign

103
Q

Hyperthyroidism anesthetic managment

A
  • Anesthetic management
    • Avoid drugs that can cause tachycardia (ketamine)
    • Need glucocorticoid supplementation (hyperthyroidism causes relative deficient body reserves of glucocorticoid)
    • If exophthalmic, be careful with eyes during GA (consider eye ointment in addition to taping of the eyes)
    • Be prepared to treat perioperative thyroid storm
104
Q

Hypothyroidism associated with the following issues (7)

A
  • Anemia
  • preeclampsia
  • fetal growth restriction
  • gestational diabetes
  • preterm delivery
  • placental abruption
  • postpartum hemorrhage
105
Q

Clinical manifestations that affect anesthetic management in hypothyroidism

A
  • Reversible myocardial dysfunction
  • CAD
  • reversible defects in hypoxic & hypercapnic ventilatory drives
  • OSA
  • paresthesias
  • prolonged SSEPs
  • abnormal peripheral nerve conduction
  • increased peripheral nociceptive thresholds
  • hyponatremia
  • anemia
  • abnormal coagulation factors & platelets
  • decreased glucocorticoid reserves
106
Q

preferred delivery choice in Pheo

A

C/S

107
Q

PHEO: These drugs to avoid

may increase (direct/indirect) CAT release by tumor

A
  • sux
  • vanc
  • morphine
  • atracurium
  • pancuronium
  • droperidol
  • glucocorticoids
  • metochlopromide
  • pentazocine
108
Q

Hg less than this, consider other causes of anemia

A

< 10.5 gm/dL

109
Q

most common cause of anemia in pregnancy

A

IDA

110
Q

Group of microcytic, hemolytic anemias resulting from reduced synthesis of 1 or more polypeptide globin chains

A

Thalassemia

111
Q
  • microcytic and hemolytic anemias in (Thalassemia) result from reduced synthesis of 1 or more polypeptide globin chains leads to the following:
A

1.) Imbalance in globin chain ratios

2.) Defective hemoglobin

3.) RBC damage resulting from excess globin subunits

112
Q

α-thalassemia (4 types):

A
  1. ) Silent carrier = no ↑ risk for pregnancy or surgery
  2. ) 𝛼-thalassemia = typically asymptomatic; no adverse outcomes for pregnancy or surgery
  3. ) Hemoglobin H disease = moderately severe microcytic anemia, splenomegaly, fatigue & general discomfort
  4. ) Hemoglobin Barts = generally incompatible with life
113
Q
  • this type of thalassemia has inc incidence of spontaneous abortions, intrauterine fetal death and fetal growth restriction
  • unusual to see preganant
A

β-thalassemia major

114
Q

this type of anemia has greater risk of oligohydramnios and fetal growth restrictions even though the clinical course is benign and tolerated well in pregnancy

A

B-thalassemia minor

115
Q

most common abnormal Hg in SCA (sickle cell an.)

A

Hg .. (“decks”)

  • D
  • E
  • C
  • S
116
Q
  • Sickle cell disease
    • Disorders in which sickling results in clinical S&S (4)
A

1.) Hgb SS disease

2.) Hgb SC disease

3.) Hgb SD disease

4.) Sickle cell β-thalassemia

117
Q

most important factor in sickling

and other factors

A

O2 tension (i.e. PaO2)

  • Hg S > 50% of total Hg
  • dehydration (inc viscosity)
  • hypotension (vascular stasis)
  • hypothermia
  • acidosis
118
Q

preferred anesthesia choice in SCA

A

NAA

GA is acceptable too

119
Q

Autoimmune thrombocytopenic purpura (ATP) preferred delivery

A

vaginal

> 80k plt consider NAA

120
Q

thrombotic thrombocytopenic purpura (TTP) and NAA implications

A

NAA NOT recommended - plt very low

121
Q

meds/substances affecting hemostasis (several)

A
  • ASA, NSAIDS (transient - NAA okay)
  • LMWH, heparin
  • Dextran
  • hydroxyethyl starch
  • omega-3 fatty acids
  • Garlic, Ginsen, & Ginko
122
Q

ASRA guideline on unfractionated heparin and NAA

A

Thrombophylaxis with twice-daily dosing of unfractionated heparin does not contraindicate use of neuraxial anesthesia as long as total daily dose is NOT > 10,000 units

123
Q

plt > this amount is usually sufficient for safe NAA

A

80,000/mm3

124
Q

most important factor to consider in thrombocytopenic pt

A

risk vs benefit of NAA

125
Q

most important means of assessing the risk of epidural hematoma

(not in notes but in Chestnut)

A

clinical judgement

(wow that was hard, nevertheless, an eye opener)

126
Q

Following Factors to Consider in Thrombocytopenic Patient

A
  • 1) Clinical evidence of bleeding
  • 2) Time interval since platelet count was measured
  • 3) Any recent change in platelet count (e.g., downward trending)
  • 4) Quality of platelet function
  • 5) Adequacy of coagulation factor level & function
  • 6) Risk vs benefit of performing neuraxial anesthesia
127
Q

all pregnant women should be screen for which hepatitis

A

hep B

128
Q
  • 2 distinct areas of discomfort for back pain:
A

1) lumbar spine area (low back)
2) posterior pelvic girdle area (sacroiliac joints radiating into posterior thighs)

129
Q

Scoliosis: Echo to assess right-sided heart function if one or more present

A

1) Curve of 60° or more;
2) Hypoxemia on ABGs;
3) ↓ predicted PFTs
4) Pulm HTN

130
Q

scoliosis: most common ABG abnormality

A

Increased A-a O2 gradient

+

dec PaO2 & Normal PaCO2

131
Q

Rheumatoid Arthritis (RA) - preferred delivery

A

vaginal delivery

132
Q

most common cause of dwarfism

A

achondroplasia

(inherited disorder of bone metabolism)

133
Q

cord lesion location associated with autonomic hyperreflexia

A

T6 or greater

(NAA preferrered to blunt)

(epidural preferred - continuous titrate up)

134
Q

major disadvantage of dural puncture (with epidural) in someone with brain neoplasm who already had increased ICP

A

Fatal brain stem herniation

135
Q

anesthetic choice of technique for obese pregnant pt

A

NAA

136
Q

Strategies for reducing risk for small airway closure, atelectasis & hypoxemia (5)

A
  • 1) FiO2 < 0.80
  • 2) TV 6-10 ml/Kg IBW
  • 3) RR maintain physiologic PaCO2
  • 4) manual or automated recruitment maneuver
  • 5) PEEP
137
Q

Renal

  • K+ > _____mEq/L recommend dialysis before elective procedure
    • Sux will cause increase of _____ mEq/L rise in K+
A
  • K+ > 5.5 mEq/L recommend dialysis before elective procedure
    • Sux will cause increase of 0.5-0.7 mEq/L rise in K+
138
Q

Anesthetic Goals in asthmatics

A

1) provision of pain relief
2) reduction in stimulus to hyperpnea
3) prevention or relief of maternal stress

139
Q

can do NAA on alcohol intoxication if: (4)

A
  • 1) patient is cooperative
  • 2) no evidence of coagulopathy
  • 3) patient is volume replete
  • 4) baseline neurologic deficits are assessed & documented
140
Q

avoid these induction agents in cocaine abuse pt

A
  • ketamine
  • etomidate (precipitate myoclonus/hyperreflexia)
141
Q

high doses of ecstacy (MDMA) may cause this

A

rhabdomyolosis

142
Q
A

943 (2 decks)

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