TL part 2 Flashcards
FHR: >15 bpm decel >30 s after uterine contraction
late deceleration: placental insufficiency
FHR: normal variability
5-25 bpm
85% of the population have [left/right] dominant circulation
right; PDA and AV node supplied by RCA
define grand multiparity
> 5 live or still at W20+
major concern during off-pump CABG
distal anastomosis of grafts to diseased arteries
most comprehensive TEE view for wall motion abnormalities
short axis transgastric view
two categories of obstructive shock
pulmonary vascular and mechanical
mechanism of local visceral pain from pancreatic adenocarcinoma
release of substance P and calcitonin gene-related peptide from vagal afferent neurons
relationship between intraop oliguria and postop AKI
no correlation
occipital horn syndrome is characterized by a deficiency in what
biliary copper excretion; enteral cells accumulate copper
PCV vs VCV: higher mean airway pressure
PCV
PCV vs VCV: higher plateau pressure
VCV
PCV vs VCV: constant inspiratory pressure
PCV
PCV vs VCV: constant inspiratory flow
VCV
consideration for young female receiving platelet transfusion
Rh typing
periop immunosuppression during renal transplant (2)
methylprednisolone and thymoglobulin
most common cardiac defect associated with omphalocele
septal defects (VSD); up to 80%
most common lung pathology in drowning
pulmonary edema
umbilical [artery/vein] better represents the acid/base status of the fetus
vein
polycythemia is defined as a hemocrit > …%
54%; increased risk of perioperative mortality
T/F: congenital muscular dystrophy patients have an increased risk of rhabdo and cardiac arrest due to MH
false; increased risk is true but not attributed to MH
gastroschisis is formed by occlusion of which vessel
omphalomesenteric artery
following donor hepatectomy when does INR peak
postop day 2; normal by day 5
T/F functional residual capacity cannot be determined by spirometry
true
centrifugal vs roller pump: air embolism
vapor-lock the centrifugal pump; roller pump will propel air embolism
timing of diagnosis for peripartum cardiomyopathy
last month of pregnancy up to 5 months after delivery
best type of anesthesia for AV fistula creation to minimize vasospasm
brachial plexus block
optimal flow in AV fistula
600 mL/min
2 primary etiology for hypocalcemia in ESRD
elevated phosphorus complexing with ionized Ca and decreased 1,25 vitamin D
albumin levels in ESRD
low; decreased synthesis and increased catabolism
sympathetic ganglion innervating the pelvic organs
superior hypogastric plexus
anatomical landmark for superior hypogastric plexus
anterior L5 caudal to aortic bifurcation
ganglion impar plexus rests anterior to which structure
sacrococcygeal ligament
first line treatment for congenital myasthenic syndrome
AChEi
mechanism of 4-diaminopyridine
increases amount of ACh released in the synaptic cleft
the hepatic arterial buffer system is regulated by what substance
adenosine
T/F caudal epidural provide relief for only stage 1 of labor
false; stages 1 (cervical dilation) and 2 (expulsion)
pretreatment with what 2 drugs can help mitigate the symptoms of febrile transfusion reaction
acetaminophen and diphenhydramine
mechanism for decreased O2 delivery in hypophosphatemia
decreased 2,3-DPG and left-shift of disassociation curve
half-life of bivalirudin
30 minutes via spontaneous proteolytic cleavage
describe the carotid baroreceptor reflex
increased in BP leads to increased parasympathetic and decreased sympathetic outflow (IX, X)
pathophysiology of preeclampsia involves … arteries
myometrial spiral arteries
preeclampsia: production of thromboxane and nitric oxide by endothelial cells
increased thromboxane production with decreased nitric oxide production
chemical composition of phosgene
COCl2
most common cause of death in hospitalized drowning patients
post-hypoxic encephalopathy
gestational age at which sufficient concentration of surfactant is achieved
W35
neonatal respiratory distress syndrome patient who fails to improve with exogenous surfactant suspect
congenital heart defect or patent ductus arteriosus
MOA for alvimopan
mu-opioid antagonist that does not cross BBB
diphenoxylate is paired with what other drug to decrease its abuse potential
atropine
MOA loperamide
phenylpiperidine opioid that does not cross BBB
opioid receptor responsible for respiratory depression
mu-2
what is the active metabolite of nitroglycerin
nitric oxide
MOA nitric oxide
increase intracellular cGMP
burns >…% have increased mortality due to infection
40
major RF for developing post-herpetic neuralgia
age; 50% in patients >50 years old
volatile with most emergence agitation/delirium
sevo
indication for CPR in VAD patient (2)
MAP < 50 mmHg or etCO2 < 20 mmHg
LVADs are sensitive to acute drops in [preload/afterload]
preload
in supine hypotension syndrome blood bypasses the inferior vena cava and returns to the heart via which pathway
paravertebral epidural veins
describe the hemodynamic changes from aortocaval compression
hypertension in upper extremities; hypotension in lower extremities
route for sux during laryngospasm in patient without IV access
intramuscular (4-5 mg/kg), lingual
magnesium toxicity is a result of blockade of which channels (3)
intracellular and extracellular Ca, and intracellular K
pathology of Lambert-Eaton syndrome
destruction of presynaptic Ca channels
nerve regeneration after cryoanalgesia occurs when
1-3 months after
what variable decreases from West Zone 1 to 3
alveolar pressure
what class of medication should be avoided in upper airway obstruction
NMB
patients with abdominal ascites have lung dynamics similar to [obstructive/restrictive] lung disease
restrictive; all lung volumes decreased but FEV1/FVC unchanged
nerve block that relieves pain only during second stage of labor
pudendal nerve block
HBV transmission rate by contaminated needle
30%
GCS: withdrawal from painful stimulus score
4
initial goal in management of patient with intracerebral hemorrhage is what
SBP < 140
T/F: seizure prophylaxis in all patients with intracerebral hemorrhage
false; only give if signs of seizure
why are children more likley to become symptomatic after venous air embolism
smaller circulatory volume and heart size
how does applying pressure to the abdomen affect preload and afterload
temporary increase in preload and afterload
what is the predicted change in etCO2 during sepsis
decreased due to respiratory compensation for metabolic acidosis
assay for HIT
serotonin release assay
differentiate type 1 vs 2 hepatorenal syndrome
type 1: acute rapid onset with high mortality within 3 weeks
what is the definitive treatment for hepatorenal syndrome
liver transplant
treatment for lower extremity complex regional pain syndrome
serial lumbar plexus blocks
hypoxic ventilatory response is mediated by what?
peripheral chemoreceptors
major contraindication for carboprost
asthmatics
age most appropriate for cleft lip repair
2 (+/- 1) months
age most appropriate for velopharyngeal insufficiency correction
6 (+/- 1) years
describe orthodeoxia
dyspnea and oxygenation worsening when standing vs supine. seen in hepatopulmonary syndrome
O2 consumption per kg in infants
6 mL/kg
threshold for intubation in patient with botulism
vital capacity < 30%
antitoxin therapy for botulism in patient > 1 year old
equine serum
when is peritoneal dialysis preferred over hemodialysis
when patient cannot tolerate large hemodynamic changes
which type of cerebal edema is associated with traumatic brain injury
cytotoxic edema; avoid corticosteroids
which organization oversees the credentialing process for pediatric procedural sedation
the joint commission
ARDSnet trial revealed that reducing what type of pressure improved mortality
plateau pressure < 30 mmHg
most efficacious PONV prevention in peds
ondansetron
TRALI: development of acute lung injury within how many hours of a transfusion
6 hours
measurement to differentiate cardiac vs non-cardiogenic pulmonary edema
PCWP; > 18 for cardiogenic
FENa < 1% suggests what location of injury
prerenal
most likely mechanism for asystole after insufflation
vagal response to peritoneal stretching
periodicity of recording vital signs in pediatric moderate sedation
every 10 minutes
periodicity of recording vital signs in pediatric deep sedation
every 5 minutes
initial fluid resuscitation in pediatric patient with severe dehydration is
20 mL/kg of isotonic salt solution
initial colloid resuscitation in pediatric patient with shock is
10 mL/kg of 5% albumin
mechanism for ECG changes during subarachnoid hemorrhage
catecholamine release causing subendocardial ischemia
electrolytes decreased with administration of TPN (3)
phosphate, potassium, magnesium
autonomic hyperreflexia syndrome occurs in patients with spinal cord injuries above what level
T5
resistance to airflow varies with airway radius to what power
4th
which type of thalassemias is more difficult to diagnose in neonatal assays?
beta
RF for adverse events during pediatric sedation (5)
ASA3, <3 mo, obesity, airway procedures, polypharmacy
daily max acetaminophen dose adult
3 grams
daily max acetaminophen dose peds
2.6 grams
CAM-ICU first question
acute change or fluctuating course
CAM-ICU second question
inattentive or easily distracted
CAM-ICU third question
altered or RASS that is not 0
CAM-ICU fourth question
disorganized thinking
mechanism of neonatal myasthenia gravis
maternal anti-AChR antibodies crossing the placenta
dose of ondansetron required for significant QT prolongation
32 mg
abnormal invasion of cytotrophoblasts into the maternal decidua is a cause of …
preeclampsia
T/F dose of caudal epidurals in peds is based on volume and not concentration of local anesthetic
true
caudal epidural for sacral nerve roots dose
0.5 mL/kg
effect of TCA on NMDA receptors
antagonist
primary cause of morbidity in patients with Afib
stroke
left ventricular outflow tract is a common origin site for what arrhythmia
PVC
MOA of TXA or aminocaproic acid
decreasing fibrinolysis by binding of plasminogen and plasmin
splinting or rapid shallow breathing in the setting of pain increases risk of developing what?
pneumonia; functional restrictive lung disease
most common cause of non-OB surgery during pregnancy
cholestasis
induction with [IV/inhalation] is faster in right to left shunt
IV; shunt allows bypassing pulmonary circulation
VSD: increasing SVR will have what effect on pulmonary blood flow
increase
number of episodes per hour needed to diagnose central sleep apnea
10
failing right ventricle depends on what structure for stroke volume
intraventricular septum
which gas is used to inflate IABPs
helium
loop and thiazide diuretics cause an [acidosis/alkalosis]
alkalosis from loss of Cl
thermodilution: reducing the volume of injectate will [over/under]estimate the cardiac output
underestimate
thermodilution: when in the respiratory cycle to perform procedure for minimal variability
end-expiration
what year did the most common transfusion related deaths change from hemolytic to TRALI
2000
what change in 2004 decreased the rates of transfusion-associated sepsis?
bacterial detection in apheresis platelets
the placenta uses what % of oxygen delivered to it
40%
during alkalotic conditions does hemoglobin’s affinity for oxygen go [up/down]
up
gabapentin binding site
a2d subunit-containing voltage gated calcium channels
equation for transmural pressure across cerebral aneurysm
MAP - ICP
this is used in the prevention of contrast-induced nephropathy
isotonic crystalloid
air trapping with atelectasis and infiltrate on CXR suspect
foreign body aspiration
term infant hemoglobin nadir
11 g/dL at 10 weeks
preterm infant hemoglobin nadir
8 g/dL at 6 weeks
hemoglobin concentration in cord blood
17 g/dL
acceleration and decelerations lasting > … minutes change the baseline fetal heart rate
10 minutes
which drug is used for transient cardiac asystole
adenosine
3 methods to avoid the windsock effect
hypotension, rapid ventricular pacing (>180), transient asystole
minute ventilation increase with PaCO2
2 L/min for every 1 mmHg increase in PaCO2
minor allergic transfusion reactions are mediated by what
IgE to soluble antigens in product
definition of lusitropy
myocardial relaxation
effect on myocardial pressure-volume loop of inodilator therapy
increased contractility, increased SV, increased CPP, decreased ASP
age threshold for increased risk of postop AKI
> 59 years old
BMI threshold for increased risk of popstop AKI
32
T/F COPD is a RF for postop AKI
true if on chronic bronchodilator
secondary target for antibodies in myasthenia gravis
muscle-specific tyrosine kinase (MuSK)
reasons for avoiding neostigmine in patient with myasthenia gravis (2)
incomplete reversal and cholinergic crisis
[high/low] platelet count is a RF for heparin resistance
high; >300k
initial treatment for heparin resistance
more heparin
when is the IABP inflated
early to late diastole
monitor that demonstrates earliest indication of inadequate ventilation in children
capnography
duration of living with myasthenia gravis before having increased risk of postop mechanical ventilation
72 months (6 years)
what is used for filtration in hemodialysis
semipermeable membrane
pancuronium side effect
SNS stimluation
8-20% of adults with asthma will experience bronchospasm after being (2)
aspirin or NSAID
early sign of respiratory failure in patient with severe asthma attack
pseudonormalization of PaCO2
ICP target in patient with head injury
< 20 mmHg
best preop test to predict AKI in setting of suprarenal aortic cross-clamping in a rupture AAA
creatinine clearance
onset time of intranasal fentanyl
7 minutes
treatment for TTP
FFP
deficiency in TTP
vWF-cleaving
3 major components of intracranial space
brain parenchyma, blood, and CSF
oxygen sat goal in the venous cannula during CPB
65%
target MAP during CPB
> 50 mmHg
anterior spinal arteries provide what percentage of the blood supply to the spinal cord
75%
techniques to ablate seizure from cortical stimulation during awake craniotomy
propofol or cold saline
INR indication for FFP
> 1.8 with signs of bleeding
antithrombin 3 levels in DIC
decreased
reason for prolonged PT in DIC
consumption of clotting factors
where are spinal cord stimulators placed
dorsal column
effect of decreased lung compliance on peak inspiratory pressure and plateau pressure
increases to both
treatment for retained placenta
nitroglycerin
order of reinfusion during acute normovolemic hemodilution
reverse order of withdrawal
for how long after acute normovolemic hemodilution can the blood be used
8 hours at room temperature
reason for deliberate hypotension during AVM embolization
decrease risk of injectate traveling to systemic circulation
type of lithotripsy safe in pregnant patients
intracorporeal laser not extracorporeal shockwave
mechanism for decreased calcium levels during ESRD
decreased conversion of 25-vitaD to 1,25-vitaD
metabolite of codeine
morphine (CYP 2D6)
T/F ibuprofen increases bleeding post-tonsillectomy
false
amount of time after achieving target temperature for initiating circulatory arrest in CPB
20-30 min
target temperature for deep hypothermic circulatory arrest
18C
congenital anomaly with maxillary hypoplasia
Crouzon
congenital anomaly that becomes easier to intubate with age
Robin sequence
onset time for idiopathic sudden sensorineural hearing loss
< 3 days; treat with hyperbaric oxygen
heart valve defect associated with ostium primum ASD
cleft anterior mitral leaflet
chronic muscle pain that can be reproduced with palpation of trigger points is called what
myofasical pain syndrome
what nerve fibers are stimulated with transcutaneous electrical nerve stimulation
A-beta, which inhibits signaling through A-delta and C pain fibers
what is the increase in maternal oxygen consumption during the second stage of labor
75%
concentration of fibrinogen in cryoprecipitate
200 mg/unit
10 units of cryoprecipitate will raise a 70 kg patients fibrinogen by what?
70 mg/dL
earliest signs (2) of diabetic autonomic neuropathy
decreased pulse rate variability followed by resting tachycardia
CPAP generally reduces cardiac output except in patients with …
cardiogenic pulmonary edema
unmyelinated nerve fibers are [easier/harder] to block with local anesthetics
easier due to increased intraneural penetration
half-life for medications is longer in [infants/children]
infants due to immature renal and hepatic systems
HBV e-antigen [postive/negative] has a higher seroconversion rate
e antigen positive
acute intermittent porphyria is exacerbated by [inducers/inhibitors] of CYP450
inducers
hyaline membrane disease is AKA
respiratory distress syndrome
