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Anesthesia > True Learn > Flashcards

True Learn Flashcards

1
Q

Most common papillary muscle that causes mitral regurgitation post MI? What blood supply?

A

Posteromedial pap
RCA

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2
Q

Symptoms of MH

A

Increase in ETCo2
Peak T waves
Lactic acidosis
Muscle rigidity

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3
Q

What’s the earliest you can restart px heparin after an uncomplicated epidural placement

A

Immediately

(Wait w placement or removal of catheter, immediately start after placement or removal)

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4
Q

What’s the most common complication of a celiac plexus block

A

Orthostatic hypotension and diarrhea

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5
Q

Reflexive movement as a response to surgical stimulus
(What level of anesthesia)

A

General

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6
Q

Safest flow meter arrangement

A

W oxygen closest to the patient/ most downstream

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7
Q

What would you expect pulse ox to read in someone w methemoglobinemia

A

85%

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8
Q

What cardiac anomaly is most common in carcinoid tumor?

A

Tricuspid regurgitation
Tricuspid stenosis (much less common)

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9
Q

Carcinoid triad

A

Wheezing
Flushing
Right heart dx

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10
Q

Volume compartments

A

Interstitial > intravascular
Intracellular = extracellular

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11
Q

Shunt fraction

A

Qs / Qt = (1n− SaO2) / (1 − SvO2), where Qs = pulmonary physiologic shunt, Qt = cardiac output, SaO2 = arterial oxygen saturation, and Sv02 = venous oxygen saturation

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12
Q

Alveolar oxygen equation

A

PaO2 = FiO2 × (Patm − PH2O)−(PaCO2 / R)
FiO2 = Fraction of inspired oxygen
Patm = atmospheric pressure = 760 mmHg
PH2O = partial pressure of water vapor = 47 mmHg
R = constant = 0.8

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13
Q

Who qualifies for early invasive cardiac strategies?

A

Worsening underlying heart disease
- recurrent angina or ischemia at rest
- elevated cardiac bio markers
- new ST depression
- new or worsening mitral regurgitation
- hemodynamic instability
- sustained tachy
- pci within 6 mos
- prior coronary artery bypass
- high risk TIMI score > 2
- reduced left ventricular function

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14
Q

What is appropriate management of epiglottitis in a pediatric patient

A

DL under deep GA

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15
Q

What are the benefits of smoking cessation and what is the optimal time for quitting?

A

Decrease carboxyhemoglobin levels
Increase in ciliary function
Decrease in sputum production
Decrease in stimulation of the cardiovascular system

8 weeks

*reduction in carboxyhemoglobin shifts the oxygen dissociation curve to the right = more oxygen unloading

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16
Q

What’s the order of invasive accretas

A

Accreta
Increta
Percreta

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17
Q

How does lidocaine cause fetal acidosis

A

Lidocaine crosses the placenta and accumulates to toxic levels due to ion trapping

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18
Q

What are the four factors that determine placental transfer of drugs

A

Size : <500 Da
Lipophilicity: lipophilic cross (fentanyl), high ionized do not
Protein binding
Maternal drug concentration

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19
Q

What drugs do not cross the placenta

A

Heparin
Insulin
Glycopyrrolate
Nondepolarizing muscle relaxants
Sux

He is going nowhere soon

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20
Q

Most common cause of adrenal insufficiency in pts w critical illness

A

Functional adrenal insufficiency : causing corticosteroid def, due to cellular dysfunction, peripheral glucocorticoid resistance, and impaired transport

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21
Q

What causes the acid base status w NS infusion

A

Metabolic acidosis due to decreased strong ion difference
SID= strong cations - strong anions
SID takes into account HCO3, albumin, phosphate, unmeasured ions

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22
Q

In pt w cirrhosis and BP what is the most common cause of ARF?

A

Type 1 HRS (acute renal failure from a precipitating event related to cirrhosis ; such as bacterial peritonitis)

Type 2 is an insidious onset of renal failure from portal htn caused by splanchnic vasodilation and activation of raas

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23
Q

What is the CAM-ICU assessment?

A

The CAM-ICU asks the following:
Is there an acute change in mental status or fluctuating course? (yes/no)
Is the patient inattentive or easily distracted? (yes/no)
Is there an altered level of consciousness or RASS other than zero? (yes/no)
Does the patient experience disorganized thinking? (yes/no)

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24
Q

Which drugs are unsafe agents to use in patients with MH?

A
  • volatile anesthetics
  • succinylcholine
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25
Q

What are the safe drugs to use in patients with MH

A
  • barbiturates
  • inhaled non-volatile anesthetics (NO)
  • local anesthetics
  • opioids
  • non-depolarizing muscle relaxants
  • benzos
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26
Q

What are the commonly used anesthetics used in ECT and what are their durations

A

Etomidate- increases seizure duration

methohexital/ ketamine- no/minimal effect on seizure duration

midazolam, propofol, lidocaine, and volatiles- decrease seizure duration

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27
Q

When does airway closure begin in patients with emphysema?

A

earlier/ closer to the alveoli

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28
Q

what is the dose for oral midazolam in pediatric patients

A

0.5mg/kg

IV is 0.05-0.1 mg/kg

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29
Q

What are the target sites for sympathetic cardiac innervation?

A

A1, B1, and B2
sympathetic cardiac innervation originates from T1-T4 and travel through bilateral stellate ganglions prior to ending as cardiac nerves

A1: positive inotropy
B1: positive chronotropy, domotropy (conductivity of a nerve), lusitropy (myocardial relaxation), and inotropy
B2: positive chronotropy > isotropy

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30
Q

What is extraction ratio?

A

fraction of drug removed from blood passing through the liver

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31
Q

which drugs have high liver extraction ratio?

A

bupivicaine, diltiazem, fentanyl, ketamine, meperidine, metoprolol, morphine, nifedipine, and propofol

these are flow dependent

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32
Q

what drugs have low hepatic extraction ratios?

A

diazepam, methadone, roc, alfentanil, and thiopental

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33
Q

What medication should be avoided in a thyroid storm?

A

salicylates (aspirin) because they compete with T3 and T4 for thyroid- binding globulin

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34
Q

signs and sxs of a thyroid storm

A

hyperthermia
hypertension, tachycardia, arrhythmia
mental status change
cardiovascular collapse
congestive hf in pts prone to hf

medications= PTU (more favorable) and methimazole and iodine after antithyroid drugs

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35
Q

what are the sympathetic block indications?

A

vascular: A/V occlusion, intra-arterial injection of irritants, raynauds, throboangiitis obliterans, vasospasm, venous insufficiency

neuropathic: acute herpes zoster, CRPS 1 & 2, phantom limb

visceral: abdominal cancer, chronic pancreatitis, refractory angina/ acute MI if medically indicated

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36
Q

What is the oculocardiac reflex

A

afferent: trigeminal nerve
efferent: vagus nerve causing Brady

Stimuli at the eye -> ciliary ganglion -> ophthalmic division of trigeminal nerve -> Gasserian ganglion -> trigeminal nucleus -> vagus nerve -> bradycardia.

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37
Q

What muscle layers are pierced in a TAP block?

A

EO and IO
local anesthetic is deposited in the plane between IO and transverses abdominis muscles

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38
Q

is mitral and aortic stenosis contraindicated in neuraxial anesthesia?

A

no
only severe aortic stenosis
mild to moderate aortic stenosis favors spinal anesthesia

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39
Q

how does Mac change in chronic and acute alcohol intoxication?

A

chronic- increases Mac
acute- decreases Mac

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40
Q

what’s the safest option of anesthesia in a pediatric patient undergoing pediatric radiation therapy?

A

propofol for deep sedation while maintaining spontaneous vent

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41
Q

how does intrathecal pumps decrease constipation

A

avoids first pass effects that you would see in chronic oral opioid therapy, which causes constipation

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42
Q

How do you manage the airway in patient’s with mediastinal masses?

A

maintained w SV w local and regional anesthesia techniques. Awake intubation and rigid bronch for advanced airway could be beneficial. Positioning in lateral decubitus is preferred to alleviate airway collapse from a supine position

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43
Q

how does abdominal surgery affect hepatic blood flow?

A

decreases, which will cause increase in liver enzymes

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44
Q

Venous compliance equation

A

change in venous volume/ change in venous pressure

  • Angiotensin 2, endothelin1, increased sympathetic tone, Valsalva maneuvers, and inotropes decrease venous compliance
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45
Q

Uterotonic medications

A

Carboprost
Methylergonovine
Misoprostol
Oxytocin

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46
Q

Side effects of carboprost and contraindications

A

SE: bronchospasms and nausea
Contraindication: reactive airway disease

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47
Q

SE and contraindications in Methylergonovine

A

SE: hypertension, vasoconstriction, coronary vasospasms
Contraindicated: hypertension and preeclampsia

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48
Q

SE/ contraindications in misoprostol

A

SE: nausea and fever
no contraindications

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49
Q

Oxytocin

A

SE: hypotension, tachy, coronary vasoconstriction, MI
used for prophylaxis

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50
Q

What is sodium bicarb’s requirement to normalize pH?

A

0.2 x patient’s weight x base deficit

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51
Q

What cardiac changes do you see with abdominal insufflation

A

bradycardia, bradyarrythmias, and asystole

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52
Q

what are the prejunctional neuromuscular disorders

A

Charcot-Marie-Tooth and Friedreich ataxia

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53
Q

what are the postjunctional neuromuscular disorders

A

DMD, BMD, myotonic dystrophy, myotonia congenita (NNMBD do not alleviate contractures), hyper and hypoK PP

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54
Q

What are the metabolic neuromuscular disorders

A

metabolism and mitochondrial disorders

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55
Q

What is the major pulmonary pathophysiology of drowning

A

pulmonary washout of surfactant

o Drowning aspirate 3-4ml/kg of surviving victims
o 11ml/kg to change blood volume
o 22ml/kg to change electrolytes

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56
Q

how does acute cocaine affect mac

A

increases

treat acute cocaine toxicity w benzos

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57
Q

What meld score poses a risk on postop liver failure

A

> 10

> 14 is not considered for surgical intervention

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58
Q

How does the body compensate for increases in intracranial volume?

A

redistribution of intracranial venous blood and CSF to extracranial veins and spinal CSF space respectively

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59
Q

What procedure is commonly performed in pseudo tumor cerebri

A

lumbar puncture to improve visual disturbances

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60
Q

what cord level injury would you see in paraplegia vs quadriplegia

A

T1 and below = para
above = quadriplegia

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61
Q

How does TENS units work?

A

involves electrical stimulation of large diameter A-beta cutaneous mechanoreceptors. This inhibits signaling through A-delta and C pain fibers, closing a “gate”

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62
Q

what is the most common occurrence leading to a malpractice claim?

A

death - 29%
nerve injury - 21 %
brain damage - 9%
airway - 6%

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63
Q

Where is serotonin stored?

A

90% of the body’s serotonin is stored in the enterochromaffin cells in the gut wall; it is triggered by toxic substances like hypertonic saline and copper sulfate

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64
Q

What reduces the release of serotonin?

A

GABA-B, 5HT4, alpha 2, VIP, and somatostatin reduce the release of serotonin

65
Q

How does CMRO2 change with temperature

A

For every 1degree C of temp drop will decrease CMRO2 by 6% and therefore decrease CBF
- CBF rises dramatically when Pa02 decreases below 50 mmhg

66
Q

What effects does large volume NS have on electrolyte and fluid changes

A

increase in ECF, hemodilution (decreased albumin and hct), increase in chloride, potassium, and decrease in bicarb

  • Leads to hyperchloremic metabolic acidosis and reduced renal perfusion
67
Q

What physiology do you see with negative pressure pulm edema?

A

increased afterload
negative intrathoracic pressure
increased pulmonary vascular resistance (from increased pulmonary vasoconstriction)
increased pulmonary blood flow

68
Q

Diabetes insipidus

A

deficiency of ADH that can be caused by pituitary disease, infiltrative disease, brain tumors, neurosurgical procedures

present w polyuria, hypernatremia, high plasma osmolality, and low urine osmolality

69
Q

What effect does cardiopulmonary bypass have on blood

A

causes platelet dysfunction and sequestration

after appropriate reversal of heparin w protamine, treatment of coagulopathy should be treated w platelet transfusion

70
Q

what element/ electrolyte promotes bronchodilation

A

mag

71
Q

What are the boundaries of the airway

A

nasopharynx: nasal cavity to soft palate
oropharynx: soft palate to hyoid bone
hypopharynx: epiglottis to the end of the cricoid cartilage
larynx contains the epiglottis and vocal cords and extends from the superior border of the epiglottis to the cricoid cartilage

72
Q

how to treat organophosphate poisoning (anticholinesterase toxicity)

A

atropine

sxs: Brady, miosis, lacrimation, salivation, bronchorrhea, bronchospasm, urination, emesis, and diarrhea

73
Q

What is the best indicator that metabolic alkalosis is resolved in pyloric stenosis

A

normalization of chloride

74
Q

how to manage acute epiglottitis airway

A

upper airways near the glottic opening should be managed by maintaining spontaneous ventilation
Typically managed w inhalation induction in the OR w surgical backup

75
Q

How does metabolic derangements affect wake up?

A

prolongs it

hyperglycemia or hypoglycemia
hyponatremia
metabolic acidosis
hypercapnia
blood toxicology
hypothermia
hypothyroidism

76
Q

contraindications to percutaneous tracheostomy

A

infants w abnormal anatomy (subglottic stenosis, tracheomalacia, tracheal stenosis) due to the difficult to palpate landmarks

in addition: operator inexperience, infants, insertion to site infection, severe/uncontrolled coagulopathy, unstable cervical spine injury

77
Q

Multi-drug resistant pathogens causing VAP coverage?

A

MRSA coverage
- Vancomycin 15 mg/kg IV every 8-12 hours
OR
- Linezolid 600 mg IV every 12 hours

PLUS

Antipseudomonal β-lactam-based agents
Antipseudomonal penicillins
- Piperacillin-tazobactam 4.5 g IV every 6 hours
OR
Cephalosporins
- Cefepime 2 g IV every 8 hours
- Ceftazidime 2 g IV every 8 hours
OR
Carbapenems
- Imipenem 500 mg IV every 6 hours
- Meropenem 1 g IV every 8 hours
OR
Monobactams
- Aztreonam 2 g IV every 8 hours

PLUS

Antipseudomonal non-β-lactam-based agents
Fluoroquinolones
- Ciprofloxacin 400 mg IV every 8 hours
- Levofloxacin 750 mg IV every 24 hours
OR
Aminoglycosides
- Amikacin 15-20 mg/kg IV every 24 hours
- Gentamicin 5-7 mg/kg IV every 24 hours
- Tobramycin 5-7 mg/kg IV every 24 hours
OR
Polymyxins
- Colistin 5 mg/kg IV load followed by a maintenance dose which is based on creatinine clearance

78
Q

What are the relative contraindications to MAC?

A

inability to lie still, inability to cooperate, inability to communicate with the care team

79
Q

FeNa<1 vs FENa >1

A

<1= poor renal perfusion and hypovolemia

> 1= acute tubular necrosis or other intrinsic renal

80
Q

pre renal kidney injury

A

BUN:Cr >20
Fena <1
UNa <20
UOsm >400

81
Q

intrinsic renal injury

A

BUN:Cr >15
Fena >1
UNa >20
UOsm <400

82
Q

Postrenal kidney injurt

A

BUN:Cr >15
Fena >4
UNa >40
UOsm <400

83
Q

CVP waveforms

A

3 waves (a, c, v), 2 descents (x, y)

a- atrial contraction
c- right ventricle contraction, tricuspid bulging
-QRS complex
v- filling of right atrium
-end of T wave
x- emptying of right ventricle
y- passive emptying of right atrium

84
Q

First step in PCA adjustments

A

adding basal infusion of opioid
then adding multimodal such as ketamine

85
Q

Increases in cardiac output in the labor period

A

latent labor = 15% increase
active labor= 30% increase
expulsive labor= 45% increase
contractions= 10-25% increase

86
Q

Changes in CV physiology during pregnancy

A

Blood volume + 35-40%
Cardiac output + 40-50%
Central venous pressure No change
Diastolic blood pressure - 10-20 mm Hg
Heart Rate + 15-20%
Femoral venous pressure + 15 mm Hg
Mean arterial blood pressure - 15 mm Hg
Plasma volume + 50%
Red blood cell volume + 20%
Systolic blood pressure - 0-15 mm Hg
Total peripheral vascular resistance - 15 mm

87
Q

risk factors for postop apnea in infants

A

GA or regionalA w IV sedation
hx of prematurity
Post conceptual age <60 esp <42-44 wks
hx of apnea
anemia

88
Q

Factors to consider in HLHS

A

its a ductal dependent systemic blood flow and control of Qp:Qs ratio is imperative
(pulmonary:systemic flow)

89
Q

risk for emergence delirium

A

children 2-6 years old
volatile anesthetics

90
Q

transplanted hearts

A

denervated and respond to direct acting agents (isoproterenol) but not vagal stimulation or indirect agonists

91
Q

What medication potentiates NMB?

A

magnesium - bc it inhibits calcium channels which triggers the release of acetylcholine and a subsequent action potential

gentamicin

acute phenytoin use

92
Q

retained epidural catheter tip

A

observation is acceptable in an asymptomatic patient

93
Q

what factors will change the confidence interval

A

narrowing: decreasing variation, increasing sample size, reducing confidence level

94
Q

Indication for FFP administration

A

TP or hemolytic uremic syndrome (HUS)

Multiple coagulation factor deficiencies with microvascular bleeding and PT and/or aPTT
>1.5-2 times normal

Urgent reversal of warfarin therapy

Correction of microvascular bleeding during massive transfusion (> 1 blood volume) when
PT/aPTT are not readily obtained

Treatment of heparin resistance in a patient requiring heparin

Single coagulation factor deficiencies when specific concentrates are not available

Management of trauma-related or massive blood loss

95
Q

When is FFP not recommended for management?

A

hemophilia A - due to large quantities required and the risk for infection

96
Q

Management of VAE

A

flood field w saline
bone wax applied to exposed bone
lower surgical site below the level of the heart
careful application of peep and compression of jugular veins

*aspirating air is rarely successful except in the setting of a massive VAE

97
Q

Are there mortality differences in resuscitation with albumin and saline?

A

no

98
Q

What is bronchopulmonary displasia and what causes it

A

chronic condition following respiratory distress syndrome characperibronchiolar fibrosis, disorganized pulmonary vasculature, airway smooth muscle hyperplasia, and enlarged alveoli, more common to occur in neonates <32 weeks

caused by oxygen toxicity, infection, inflammation, barotrauma

99
Q

Layers of the spinal cord

A

meninges composed of 3 different layers
dura mater
arachnoid
pia
Pia then extends to film terminale after L1

100
Q

What is the treatment for pruritus from neuraxial morphine

A

nalbuphine
antihistamines have little to no effect

101
Q

how does diuretics change the frank-starling curve

A

leads to movement downward along the curve

102
Q

difference between type 1 and 2 CRPS

A

type 1- absence of nerve trauma
type 2- presence of nerve injury

103
Q

What is adenosine used to treat

A

SVT (the most common arrhythmia in pregnancy)

104
Q

How long does dual anti-platelet therapy need to be held for elective surgery?

A

after six months needs to be held for 5-7 days but aspirin may be continued

105
Q

What processes cause a decreased production of CO2

A

hypothermia
hypothyroid
neuromuscular blockade

106
Q

What impairs co2 elimination

A

cardiovascular collapse
massive VAE: increased end tidal nitrogen
large PE: ecg showing s1-q3 pattern
dislodged or kinked ETT, esophageal intubation: low and rapidly falling SpO2

107
Q

What are pts who get multiple transfusions at risk for?

A

alloimunization against minor red blood cell antigens which delay the crossmatch process

108
Q

how should the hospital manage a sudden hospital disaster? especially in the setting of viral pathogens?

A

tiered staffing

109
Q

How does burns affect fibrinogen?

A

triggers an inflammatory response that then increases fibrinogen (AFR) which propagates platelet aggregation, causing thrombocytopenia

110
Q

Parkland formula

A

4ml/kg x % of TBSA
1/2 given in first 8hrs, rest given in 16 hrs
after 24hrs, use colloid for resuscitation

111
Q

Carbamazepine toxicity

A

hyperthermia, flushing, dry mouth, midriasis, urinary retention, widened QRS, prolonged QT, ventricular arrhythmia, tacky, hypotension

112
Q

What physiological changes are seen after brain death?

A

myocardial dysfunction
catecholamine storm followed by hemodynamic instability
hypovolemia
pulm edema
hyperglycemia
hypernatremia
polyuria - due to DI 2/2 posterior pituitary ischemia

113
Q

What do you avoid intraoperatively in pts w VPS

A

elevation in pc02
intraabdominal pressure
intrathoracic pressure

114
Q

subdural spinal injection

A

presents with varying degrees of motor, sensory, and sympathetic block with a much slower onset (10-30 min) than w intrathecal

115
Q

What do you use to treat hypernatremic, hyperosmolar, polyuric pts w seizures

A

free water at 1-3mmol/ hr

116
Q

What to give in pt w radiation-induced injury to the thyroid

A

potassium iodide

117
Q

How does hypocalcemia affect ecg

A

prolongs QT

118
Q

What usually causes anaphylactic reactions to blood transfusions

A

IgA deficiency

119
Q

sacral spinal nerves

A

includes the parasympathetic nerve fibers that promote sexual arousal, intestinal peristalsis, defecation, and urination

120
Q

Classic findings of trisomy 21

A

single palmar crease, upslanting palpebral fissures, endocardial cushion defects, atlantoaxial instability, and sleep apnea

121
Q

classic findings of trisomy 18

A

VSDs, “rocker-bottom” feet, and clenched hand with overlapping digits

122
Q

classic findings of trisomy 13

A

holoprosencephaly, cleft lip, absent ribs, and polydactyly.

123
Q

Classic finding of trisomy 8

A

long face, wide nose, thick lower lip, and cleft palate

124
Q

medications that stimulate the SNS and when to use cautiously

A

in hyperthyroidism
- pancuronium, ketamine, atropine, epinephrine, and ephedrine

125
Q

medications to prevent and treat high altitude pulmonary edema (HAPE)

A
  • HAPE results from diffuse hypoxic pulmonary vasoconstriction in response to the low partial pressure of oxygen at altitude which results in increased hydrostatic capillary pressure, causing pulmonary edema

px tx= nifedipine and PDE5 inhibitors

126
Q

What causes an increase in both peak inspiratory and plateau pressures?

A

elastic resistance (compliance) decreases
- abd insufflation
- ascites
- intrinsic lung disease
- obesity
- pulm edema
- tension pneumo
- trendelenburg

*bronchospasm, ETT kink, mucus plus, secretions, airway obstruction would have a normal plateau pressure

127
Q

What is Goldenhar syndrome

A

oculo-auriculo-vertebral spectrum (OAVS)

characterized by hemifacial microsomia as well as mandibular hypoplasia, epibulbar dermoid, and vertebral anomalies

128
Q

What percentage of spinal cord blood supply comes from the anterior spinal artery

A

75%

arterior spinal artery: supplies the motor tracts in the spinal cord

posterior SA: sensory tracts

129
Q

Stroke volume variation

A

SVmax- SVmin/ (average of SVmax of Svmin)

130
Q

cryoablation

A

disintegration of the myelin sheath leading to wallerian nerve degeneration

131
Q

what area does sciatic block not cover

A

medial lower leg

132
Q

interscalene block

A

what structure is posterior-lateral to the brachial plexus
- middle scalene muscle

133
Q

internal defibrillation biphasic shock sequence

A

5J, 10J, 20J, 30J, 50J

134
Q

When do you use retrograde cardioplegia

A

aortic insufficiency
severe CAD

135
Q

sacroiliac pain

A

provocation of compression and distraction and gaenslen’s test

136
Q

serial lumbar plexus block is used for

A

CRPS
can lead to sympathetic dysfunction

137
Q

what happens with hydromorphone in renal failure

A

hydromorphone-3-glucoronide causes dysfunction and myoclonus

138
Q

What is one of the greatest risks for malpractice in anesthesia

A

residual anesthetic medication in the recovery room

139
Q

Normal hemodynamic values

A

CVP: 2-6mmHg
PCWP: 6-12mmHg
CI:2.5-4L/min/m2
SVR: 800-122 dynes

140
Q

Static compliance equation

A

TV/ Pplateau-PEEP

141
Q

How much uterine blood flow does ovarian arteries supply

A

15%

uterine artery supplies 85%
- uterus receives up to 20% of maternal CO
-vili form on the fetal side of the placenta, resp for gas, nutrients, and waste with the intervillous space

142
Q

blood gas for methemoglobinemia

A

only thing that will change is the partial pressure of oxygen PaO2

143
Q

what does citrate do to the body?

A

citrate is added to prbcs for storage and is metabolized into bicarb and may cause metabolic alkalosis

144
Q

what medication can increase lower esophageal sphincter tone

A

metoclopramide

145
Q

what medication can worsen acute hypertension during adrenalectomy for pheochromocytoma

A

b-blockers especially w/o adrenergic activity
- alpha antagonism should be first

146
Q

What are the most common risks of MAC

A

airway fire and respiratory depression

147
Q

Carotid body chemoreceptors

A

afferent glossopharyngeal nerve
- increases ventilation when pao2 decreases
function impaired by opioids, benzos, volatile anesthetics, and bilateral carotid endarterectomy

148
Q

What genetic syndrome is associated with vocal cord paresis

A

acromegaly - due to stretching of the recurrent laryngeal nerve

149
Q

What is the most common cause of maternal death due to preeclampsia

A

CVA

150
Q

what is the issue with using radioactive iodine alone for thyrotoxicosis

A

it can worsen it

151
Q

difference between acute and delayed hemolytic transfusion reactions

A

Acute hemolytic transfusion reactions develop due to ABO incompatibility while delayed hemolytic transfusion reactions occur due to alloantibodies to minor red blood cell antigens such as Rh, Kell, Kidd, Duffy, and other antigens

152
Q

What is acog definition of preeclampsia

A

gestational hypertension with proteinuria or with severe End organ dysfunction

153
Q

What is the frankenhauser ganglion?

A

uterovaginal plexus - blocked by injecting anesthetic lateral to the cervix in the fornix of the vagina.

can cause fetal bradycardia associated with fetal deoxygenation and acidosis

154
Q

Klippel-Feil syndrome

A

congenital condition associated with cervical spine fusion

155
Q

What produces more carbon monoxide between barium hydroxide and soda lime? and why?

A

Barium hydroxide due to the decreased water content of barium hydroxide absorbents
- in addition barium hydroxide has the highest risk for fire production and produces the most compound A with sevoflurane

156
Q

HHS

A

occurs in type 2 diabetes, ph >7.3, bicarb >18, serum osm >320
neurological sxs occur including seizures due to extracellular shift of cerebral fluid

157
Q

MOA of local anesthetics

A

reversibly binds the intracellular portion of voltage gates sodium channels

158
Q

La place law

A

PR/2h=wall tension
H= wall thickness
Aortic stenosis - phenylephrine to increase pressure at the coronary Ostia to increase precision

Anesthesia (1 decks)

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