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ITE-Anes > TL part 2 > Flashcards

TL part 2 Flashcards

1
Q

FHR: >15 bpm decel >30 s after uterine contraction

A

late deceleration: placental insufficiency

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2
Q

FHR: normal variability

A

5-25 bpm

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3
Q

85% of the population have [left/right] dominant circulation

A

right; PDA and AV node supplied by RCA

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4
Q

define grand multiparity

A

> 5 live or still at W20+

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5
Q

major concern during off-pump CABG

A

distal anastomosis of grafts to diseased arteries

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6
Q

most comprehensive TEE view for wall motion abnormalities

A

short axis transgastric view

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7
Q

two categories of obstructive shock

A

pulmonary vascular and mechanical

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8
Q

mechanism of local visceral pain from pancreatic adenocarcinoma

A

release of substance P and calcitonin gene-related peptide from vagal afferent neurons

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9
Q

relationship between intraop oliguria and postop AKI

A

no correlation

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10
Q

occipital horn syndrome is characterized by a deficiency in what

A

biliary copper excretion; enteral cells accumulate copper

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11
Q

PCV vs VCV: higher mean airway pressure

A

PCV

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12
Q

PCV vs VCV: higher plateau pressure

A

VCV

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13
Q

PCV vs VCV: constant inspiratory pressure

A

PCV

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14
Q

PCV vs VCV: constant inspiratory flow

A

VCV

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15
Q

consideration for young female receiving platelet transfusion

A

Rh typing

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16
Q

periop immunosuppression during renal transplant (2)

A

methylprednisolone and thymoglobulin

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17
Q

most common cardiac defect associated with omphalocele

A

septal defects (VSD); up to 80%

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18
Q

most common lung pathology in drowning

A

pulmonary edema

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19
Q

umbilical [artery/vein] better represents the acid/base status of the fetus

A

vein

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20
Q

polycythemia is defined as a hemocrit > …%

A

54%; increased risk of perioperative mortality

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21
Q

T/F: congenital muscular dystrophy patients have an increased risk of rhabdo and cardiac arrest due to MH

A

false; increased risk is true but not attributed to MH

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22
Q

gastroschisis is formed by occlusion of which vessel

A

omphalomesenteric artery

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23
Q

following donor hepatectomy when does INR peak

A

postop day 2; normal by day 5

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24
Q

T/F functional residual capacity cannot be determined by spirometry

A

true

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25
Q

centrifugal vs roller pump: air embolism

A

vapor-lock the centrifugal pump; roller pump will propel air embolism

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26
Q

timing of diagnosis for peripartum cardiomyopathy

A

last month of pregnancy up to 5 months after delivery

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27
Q

best type of anesthesia for AV fistula creation to minimize vasospasm

A

brachial plexus block

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28
Q

optimal flow in AV fistula

A

600 mL/min

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29
Q

2 primary etiology for hypocalcemia in ESRD

A

elevated phosphorus complexing with ionized Ca and decreased 1,25 vitamin D

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30
Q

albumin levels in ESRD

A

low; decreased synthesis and increased catabolism

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31
Q

sympathetic ganglion innervating the pelvic organs

A

superior hypogastric plexus

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32
Q

anatomical landmark for superior hypogastric plexus

A

anterior L5 caudal to aortic bifurcation

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33
Q

ganglion impar plexus rests anterior to which structure

A

sacrococcygeal ligament

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34
Q

first line treatment for congenital myasthenic syndrome

A

AChEi

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35
Q

mechanism of 4-diaminopyridine

A

increases amount of ACh released in the synaptic cleft

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36
Q

the hepatic arterial buffer system is regulated by what substance

A

adenosine

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37
Q

T/F caudal epidural provide relief for only stage 1 of labor

A

false; stages 1 (cervical dilation) and 2 (expulsion)

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38
Q

pretreatment with what 2 drugs can help mitigate the symptoms of febrile transfusion reaction

A

acetaminophen and diphenhydramine

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39
Q

mechanism for decreased O2 delivery in hypophosphatemia

A

decreased 2,3-DPG and left-shift of disassociation curve

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40
Q

half-life of bivalirudin

A

30 minutes via spontaneous proteolytic cleavage

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41
Q

describe the carotid baroreceptor reflex

A

increased in BP leads to increased parasympathetic and decreased sympathetic outflow (IX, X)

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42
Q

pathophysiology of preeclampsia involves … arteries

A

myometrial spiral arteries

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43
Q

preeclampsia: production of thromboxane and nitric oxide by endothelial cells

A

increased thromboxane production with decreased nitric oxide production

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44
Q

chemical composition of phosgene

A

COCl2

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45
Q

most common cause of death in hospitalized drowning patients

A

post-hypoxic encephalopathy

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46
Q

gestational age at which sufficient concentration of surfactant is achieved

A

W35

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47
Q

neonatal respiratory distress syndrome patient who fails to improve with exogenous surfactant suspect

A

congenital heart defect or patent ductus arteriosus

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48
Q

MOA for alvimopan

A

mu-opioid antagonist that does not cross BBB

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49
Q

diphenoxylate is paired with what other drug to decrease its abuse potential

A

atropine

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50
Q

MOA loperamide

A

phenylpiperidine opioid that does not cross BBB

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51
Q

opioid receptor responsible for respiratory depression

A

mu-2

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52
Q

what is the active metabolite of nitroglycerin

A

nitric oxide

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53
Q

MOA nitric oxide

A

increase intracellular cGMP

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54
Q

burns >…% have increased mortality due to infection

A

40

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55
Q

major RF for developing post-herpetic neuralgia

A

age; 50% in patients >50 years old

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56
Q

volatile with most emergence agitation/delirium

A

sevo

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57
Q

indication for CPR in VAD patient (2)

A

MAP < 50 mmHg or etCO2 < 20 mmHg

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58
Q

LVADs are sensitive to acute drops in [preload/afterload]

A

preload

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59
Q

in supine hypotension syndrome blood bypasses the inferior vena cava and returns to the heart via which pathway

A

paravertebral epidural veins

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60
Q

describe the hemodynamic changes from aortocaval compression

A

hypertension in upper extremities; hypotension in lower extremities

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61
Q

route for sux during laryngospasm in patient without IV access

A

intramuscular (4-5 mg/kg), lingual

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62
Q

magnesium toxicity is a result of blockade of which channels (3)

A

intracellular and extracellular Ca, and intracellular K

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63
Q

pathology of Lambert-Eaton syndrome

A

destruction of presynaptic Ca channels

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64
Q

nerve regeneration after cryoanalgesia occurs when

A

1-3 months after

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65
Q

what variable decreases from West Zone 1 to 3

A

alveolar pressure

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66
Q

what class of medication should be avoided in upper airway obstruction

A

NMB

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67
Q

patients with abdominal ascites have lung dynamics similar to [obstructive/restrictive] lung disease

A

restrictive; all lung volumes decreased but FEV1/FVC unchanged

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68
Q

nerve block that relieves pain only during second stage of labor

A

pudendal nerve block

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69
Q

HBV transmission rate by contaminated needle

A

30%

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70
Q

GCS: withdrawal from painful stimulus score

A

4

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71
Q

initial goal in management of patient with intracerebral hemorrhage is what

A

SBP < 140

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72
Q

T/F: seizure prophylaxis in all patients with intracerebral hemorrhage

A

false; only give if signs of seizure

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73
Q

why are children more likley to become symptomatic after venous air embolism

A

smaller circulatory volume and heart size

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74
Q

how does applying pressure to the abdomen affect preload and afterload

A

temporary increase in preload and afterload

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75
Q

what is the predicted change in etCO2 during sepsis

A

decreased due to respiratory compensation for metabolic acidosis

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76
Q

assay for HIT

A

serotonin release assay

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77
Q

differentiate type 1 vs 2 hepatorenal syndrome

A

type 1: acute rapid onset with high mortality within 3 weeks

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78
Q

what is the definitive treatment for hepatorenal syndrome

A

liver transplant

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79
Q

treatment for lower extremity complex regional pain syndrome

A

serial lumbar plexus blocks

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80
Q

hypoxic ventilatory response is mediated by what?

A

peripheral chemoreceptors

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81
Q

major contraindication for carboprost

A

asthmatics

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82
Q

age most appropriate for cleft lip repair

A

2 (+/- 1) months

83
Q

age most appropriate for velopharyngeal insufficiency correction

A

6 (+/- 1) years

84
Q

describe orthodeoxia

A

dyspnea and oxygenation worsening when standing vs supine. seen in hepatopulmonary syndrome

85
Q

O2 consumption per kg in infants

A

6 mL/kg

86
Q

threshold for intubation in patient with botulism

A

vital capacity < 30%

87
Q

antitoxin therapy for botulism in patient > 1 year old

A

equine serum

88
Q

when is peritoneal dialysis preferred over hemodialysis

A

when patient cannot tolerate large hemodynamic changes

89
Q

which type of cerebal edema is associated with traumatic brain injury

A

cytotoxic edema; avoid corticosteroids

90
Q

which organization oversees the credentialing process for pediatric procedural sedation

A

the joint commission

91
Q

ARDSnet trial revealed that reducing what type of pressure improved mortality

A

plateau pressure < 30 mmHg

92
Q

most efficacious PONV prevention in peds

A

ondansetron

93
Q

TRALI: development of acute lung injury within how many hours of a transfusion

A

6 hours

94
Q

measurement to differentiate cardiac vs non-cardiogenic pulmonary edema

A

PCWP; > 18 for cardiogenic

95
Q

FENa < 1% suggests what location of injury

A

prerenal

96
Q

most likely mechanism for asystole after insufflation

A

vagal response to peritoneal stretching

97
Q

periodicity of recording vital signs in pediatric moderate sedation

A

every 10 minutes

98
Q

periodicity of recording vital signs in pediatric deep sedation

A

every 5 minutes

99
Q

initial fluid resuscitation in pediatric patient with severe dehydration is

A

20 mL/kg of isotonic salt solution

100
Q

initial colloid resuscitation in pediatric patient with shock is

A

10 mL/kg of 5% albumin

101
Q

mechanism for ECG changes during subarachnoid hemorrhage

A

catecholamine release causing subendocardial ischemia

102
Q

electrolytes decreased with administration of TPN (3)

A

phosphate, potassium, magnesium

103
Q

autonomic hyperreflexia syndrome occurs in patients with spinal cord injuries above what level

A

T5

104
Q

resistance to airflow varies with airway radius to what power

A

4th

105
Q

which type of thalassemias is more difficult to diagnose in neonatal assays?

A

beta

106
Q

RF for adverse events during pediatric sedation (5)

A

ASA3, <3 mo, obesity, airway procedures, polypharmacy

107
Q

daily max acetaminophen dose adult

A

3 grams

108
Q

daily max acetaminophen dose peds

A

2.6 grams

109
Q

CAM-ICU first question

A

acute change or fluctuating course

110
Q

CAM-ICU second question

A

inattentive or easily distracted

111
Q

CAM-ICU third question

A

altered or RASS that is not 0

112
Q

CAM-ICU fourth question

A

disorganized thinking

113
Q

mechanism of neonatal myasthenia gravis

A

maternal anti-AChR antibodies crossing the placenta

114
Q

dose of ondansetron required for significant QT prolongation

A

32 mg

115
Q

abnormal invasion of cytotrophoblasts into the maternal decidua is a cause of …

A

preeclampsia

116
Q

T/F dose of caudal epidurals in peds is based on volume and not concentration of local anesthetic

A

true

117
Q

caudal epidural for sacral nerve roots dose

A

0.5 mL/kg

118
Q

effect of TCA on NMDA receptors

A

antagonist

119
Q

primary cause of morbidity in patients with Afib

A

stroke

120
Q

left ventricular outflow tract is a common origin site for what arrhythmia

A

PVC

121
Q

MOA of TXA or aminocaproic acid

A

decreasing fibrinolysis by binding of plasminogen and plasmin

122
Q

splinting or rapid shallow breathing in the setting of pain increases risk of developing what?

A

pneumonia; functional restrictive lung disease

123
Q

most common cause of non-OB surgery during pregnancy

A

cholestasis

124
Q

induction with [IV/inhalation] is faster in right to left shunt

A

IV; shunt allows bypassing pulmonary circulation

125
Q

VSD: increasing SVR will have what effect on pulmonary blood flow

A

increase

126
Q

number of episodes per hour needed to diagnose central sleep apnea

A

10

127
Q

failing right ventricle depends on what structure for stroke volume

A

intraventricular septum

128
Q

which gas is used to inflate IABPs

A

helium

129
Q

loop and thiazide diuretics cause an [acidosis/alkalosis]

A

alkalosis from loss of Cl

130
Q

thermodilution: reducing the volume of injectate will [over/under]estimate the cardiac output

A

underestimate

131
Q

thermodilution: when in the respiratory cycle to perform procedure for minimal variability

A

end-expiration

132
Q

what year did the most common transfusion related deaths change from hemolytic to TRALI

A

2000

133
Q

what change in 2004 decreased the rates of transfusion-associated sepsis?

A

bacterial detection in apheresis platelets

134
Q

the placenta uses what % of oxygen delivered to it

A

40%

135
Q

during alkalotic conditions does hemoglobin’s affinity for oxygen go [up/down]

A

up

136
Q

gabapentin binding site

A

a2d subunit-containing voltage gated calcium channels

137
Q

equation for transmural pressure across cerebral aneurysm

A

MAP - ICP

138
Q

this is used in the prevention of contrast-induced nephropathy

A

isotonic crystalloid

139
Q

air trapping with atelectasis and infiltrate on CXR suspect

A

foreign body aspiration

140
Q

term infant hemoglobin nadir

A

11 g/dL at 10 weeks

141
Q

preterm infant hemoglobin nadir

A

8 g/dL at 6 weeks

142
Q

hemoglobin concentration in cord blood

A

17 g/dL

143
Q

acceleration and decelerations lasting > … minutes change the baseline fetal heart rate

A

10 minutes

144
Q

which drug is used for transient cardiac asystole

A

adenosine

145
Q

3 methods to avoid the windsock effect

A

hypotension, rapid ventricular pacing (>180), transient asystole

146
Q

minute ventilation increase with PaCO2

A

2 L/min for every 1 mmHg increase in PaCO2

147
Q

minor allergic transfusion reactions are mediated by what

A

IgE to soluble antigens in product

148
Q

definition of lusitropy

A

myocardial relaxation

149
Q

effect on myocardial pressure-volume loop of inodilator therapy

A

increased contractility, increased SV, increased CPP, decreased ASP

150
Q

age threshold for increased risk of postop AKI

A

> 59 years old

151
Q

BMI threshold for increased risk of popstop AKI

A

32

152
Q

T/F COPD is a RF for postop AKI

A

true if on chronic bronchodilator

153
Q

secondary target for antibodies in myasthenia gravis

A

muscle-specific tyrosine kinase (MuSK)

154
Q

reasons for avoiding neostigmine in patient with myasthenia gravis (2)

A

incomplete reversal and cholinergic crisis

155
Q

[high/low] platelet count is a RF for heparin resistance

A

high; >300k

156
Q

initial treatment for heparin resistance

A

more heparin

157
Q

when is the IABP inflated

A

early to late diastole

158
Q

monitor that demonstrates earliest indication of inadequate ventilation in children

A

capnography

159
Q

duration of living with myasthenia gravis before having increased risk of postop mechanical ventilation

A

72 months (6 years)

160
Q

what is used for filtration in hemodialysis

A

semipermeable membrane

161
Q

pancuronium side effect

A

SNS stimluation

162
Q

8-20% of adults with asthma will experience bronchospasm after being (2)

A

aspirin or NSAID

163
Q

early sign of respiratory failure in patient with severe asthma attack

A

pseudonormalization of PaCO2

164
Q

ICP target in patient with head injury

A

< 20 mmHg

165
Q

best preop test to predict AKI in setting of suprarenal aortic cross-clamping in a rupture AAA

A

creatinine clearance

166
Q

onset time of intranasal fentanyl

A

7 minutes

167
Q

treatment for TTP

A

FFP

168
Q

deficiency in TTP

A

vWF-cleaving

169
Q

3 major components of intracranial space

A

brain parenchyma, blood, and CSF

170
Q

oxygen sat goal in the venous cannula during CPB

A

65%

171
Q

target MAP during CPB

A

> 50 mmHg

172
Q

anterior spinal arteries provide what percentage of the blood supply to the spinal cord

A

75%

173
Q

techniques to ablate seizure from cortical stimulation during awake craniotomy

A

propofol or cold saline

174
Q

INR indication for FFP

A

> 1.8 with signs of bleeding

175
Q

antithrombin 3 levels in DIC

A

decreased

176
Q

reason for prolonged PT in DIC

A

consumption of clotting factors

177
Q

where are spinal cord stimulators placed

A

dorsal column

178
Q

effect of decreased lung compliance on peak inspiratory pressure and plateau pressure

A

increases to both

179
Q

treatment for retained placenta

A

nitroglycerin

180
Q

order of reinfusion during acute normovolemic hemodilution

A

reverse order of withdrawal

181
Q

for how long after acute normovolemic hemodilution can the blood be used

A

8 hours at room temperature

182
Q

reason for deliberate hypotension during AVM embolization

A

decrease risk of injectate traveling to systemic circulation

183
Q

type of lithotripsy safe in pregnant patients

A

intracorporeal laser not extracorporeal shockwave

184
Q

mechanism for decreased calcium levels during ESRD

A

decreased conversion of 25-vitaD to 1,25-vitaD

185
Q

metabolite of codeine

A

morphine (CYP 2D6)

186
Q

T/F ibuprofen increases bleeding post-tonsillectomy

A

false

187
Q

amount of time after achieving target temperature for initiating circulatory arrest in CPB

A

20-30 min

188
Q

target temperature for deep hypothermic circulatory arrest

A

18C

189
Q

congenital anomaly with maxillary hypoplasia

A

Crouzon

190
Q

congenital anomaly that becomes easier to intubate with age

A

Robin sequence

191
Q

onset time for idiopathic sudden sensorineural hearing loss

A

< 3 days; treat with hyperbaric oxygen

192
Q

heart valve defect associated with ostium primum ASD

A

cleft anterior mitral leaflet

193
Q

chronic muscle pain that can be reproduced with palpation of trigger points is called what

A

myofasical pain syndrome

194
Q

what nerve fibers are stimulated with transcutaneous electrical nerve stimulation

A

A-beta, which inhibits signaling through A-delta and C pain fibers

195
Q

what is the increase in maternal oxygen consumption during the second stage of labor

A

75%

196
Q

concentration of fibrinogen in cryoprecipitate

A

200 mg/unit

197
Q

10 units of cryoprecipitate will raise a 70 kg patients fibrinogen by what?

A

70 mg/dL

198
Q

earliest signs (2) of diabetic autonomic neuropathy

A

decreased pulse rate variability followed by resting tachycardia

199
Q

CPAP generally reduces cardiac output except in patients with …

A

cardiogenic pulmonary edema

200
Q

unmyelinated nerve fibers are [easier/harder] to block with local anesthetics

A

easier due to increased intraneural penetration

201
Q

half-life for medications is longer in [infants/children]

A

infants due to immature renal and hepatic systems

202
Q

HBV e-antigen [postive/negative] has a higher seroconversion rate

A

e antigen positive

203
Q

acute intermittent porphyria is exacerbated by [inducers/inhibitors] of CYP450

A

inducers

204
Q

hyaline membrane disease is AKA

A

respiratory distress syndrome

ITE-Anes (2 decks)

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