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Areviewbook > Truelearn Advanced > Flashcards

Truelearn Advanced Flashcards

1
Q

Sodium bicarbonate added to local anesthetic decreases pain and increases onset due to

A

More unionized fraction due to higher pH so more ions pass through unionized cytoplasmic membrane faster

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2
Q

Using Succ or volatile anesthetic in patient with Becker’s muscular dystrophy/or chill vac’s can lead to

A

Rhabdomyolysis

Can lead to rapid hyperkalemia formation which leads to wide qrs and then v fib

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3
Q

Absolute contraindications to ECT

A

Intracranial mass lesion
Pheo
Unstable cervical spine
Recent MI within 4-6 weeks

Pregnancy is a relative contraindication

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4
Q

MH has higher

A

ETC02 and muscle rigidity and temp increas than thyroid storm

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5
Q

Veins arterioles more stiff

A

As you age and less compliant. Leads to high SVR and LV hypertrophy

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6
Q

Dobutamine on elderly causes

A

Tachycardia/ reduced diastolic filling time and some increase in contractility leading to decreased end diastolic volume and ultimately decreased cardiac output

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7
Q

Posterior fossa surgery best way to monitor brain stem ischemia

A

Auditory evoked potentials

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8
Q

Opioids usually don’t affect evoked potentials

A

Don’t

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9
Q

Apnea brain death test

A

No spontaneous breath up to pac02 of 60

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10
Q

After thigh tourniquet release

A

End tidal co2 increases transiently

Distal tissues go from aerobic to anaerobic metabolism

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11
Q

Severe drop in ETC02 after tourniquet release think

A

PE

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12
Q

SVR is increased in obstructive shock to help with

A

Low cardiac output state

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13
Q

Distributive shock

A

Spinal cord injury leading to neurogenic shock

Biggest predictor is a loss of SVR

In hypovolemic shock SVR up

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14
Q

Volatile anesthetics least affect

A

Brainstem auditory evoked potentials

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15
Q

Need to evaluate SSEPs for

A

Spine surgery

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16
Q

Management of hypermagnesium

A

It is renally excreted so more likely in patients with renal disease

5-9 mg/dL normal range for preeclampsia patients

Depresses cardiac muscle contractility and function

Don’t give theophylline to treat

Treatment includes calcium, dialysis, loop diuretic plus saline

It prolongs succ and potentiates NMDBs(makes them work longer)

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17
Q

Nerve regeneration after cryoanalgesia takes

A

1-3 months

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18
Q

Opioid only regional anesthesia can’t be used for cystoscopy in patient with spinal cord transection

A

Still get autonomic hyperreflexia

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19
Q

AH

A

Acute hypertension, reflex bradycardia, cardiac arrhythmias, MI, pallor, coolness is lower extremity, sweating in upper extremity

Starts 2 to 6 weeks after surgery

Get Vasodilation above and vasoconstriction below

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20
Q

Volatile inhalational induction faster in infants due to

A

Greater fraction of cardiac output to the vessel rich group

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21
Q

Phrenic nerve stimulators are used to improve

A

Atelectasis

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22
Q

Hypotension decreases

A

Uterine perfusion.

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23
Q

Partial bilateral RLN injury

A

Complete obstruction

Get unopposed adduction

With complete it affects both abduction and adduction so stay in a para median position

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24
Q

ECT causes an increase in

A

ICP and cerebral blood flow which is of concern to patients with space occupying lesions

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25
Q

During ECT can see

A

Bradycardia tachycardia and short term memory loss

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26
Q

To reverse in pregnant patient with neostigmine use

A

Atropine bc glycopyrolate doesn’t cross BBB

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27
Q

Vasodilation occurs with magnesium therapy and can

A

Lower BP

Mag competes with calcium inside vascular smooth muscle cells

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28
Q

Mag inhibits

A

Voltage gated calcium channels

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29
Q

Don’t add potassium to maintenance fluid until you have good

A

Urine output

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30
Q

Pyloric stenosis high risk for

A

Postop apnea due to alterations in CSF ph and central chemoreceptor response to C02, therefore minimize opioid use and hyperventilating

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31
Q

No shivering thermogenesis in infants from

A

Norepinephrine, glucocorticoid, and thyroxine

Inhibited by inhalational anesthetics and beta blockers

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32
Q

Successful stellate ganglion block

A

Temporary sympathectimy to face and eye

Stellate ganglion block can lead to inability to sweat and flushed skin

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33
Q

ARDS more Fi02

A

Doesn’t help bc they are shunting leading to hypoxemia

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34
Q

ECMO bypasses the lungs and can help with

A

Gas exchange in ARDS

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35
Q

To anesthetize the lateral forearm need to get

A

Choracobrachialis muscle to anesthetize the musculocutaneous nerve

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36
Q

Syringomyelia

A

Causes central cord syndrome with maintenance of proprioception, touch and vibration and plus loss of pain and temperature sensation

Associated with Chiaari 1 and trauma

Fluid filled cyst in center of spinal cord

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37
Q

Diminished sweating with

A

Autonomic neuropathy

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38
Q

When anemia was present

A

An improvement in clot strength and quality was seen

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39
Q

Low biphasic waveform defibrillation has more success than

A

Monophasic waveform defibrillation

Longer the patient has had an arrhythmia the more difficult it is to defibrillate

Want 12cm electrodes

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40
Q

Plasma half life of methadone

A

13 to 50 hours but analgesic affect is 4-8 hours

For ESRD lower methadone dose 50%

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41
Q

Methadone

A

Mu receptor agonist
NMDA antagonist
MAO reuptake inhibitor

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42
Q

Methadone black box warning

A

Death from respiratory depression
Cardiac effects
Arrhythmias like torsades

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43
Q

Congenital emphysema do not give

A

Nitrous oxide

For a bleb don’t give positive pressure as it may increase the size or rupture the bleb. Use spontaneous ventilation

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44
Q

Botox works by

A

Inhibition of intracellular fusion of Ach containing vesicles

Not inhibition of bonding of AcH to receptor

Toxin only affects exocytosis thus the release of Ach going into the membrane thus those Ach molecules never reach the receptor

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45
Q

To avoid Dural puncture headache use

A

Smallest(27 gauge) non cutting needle

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46
Q

Risk factors for PDPH

A

Young age
Pregnant
Hx headaches
Large bore cutting needle

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47
Q

To improve pulmonary artery flow during a tet spell

A

Increase SVR with phenylephrine

Increase PVR shunts blood through vsd. SVR becomes less than PVR and blood goes to path of least resistance.

Phenylephrine increases SVR thus increasing pulmonary blood flow and reflex brady decreases hypercontractility

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48
Q

Intrascalene blocks commonly cause ipsilateral

A

Horners syndrome which includes ptsois, miosis, and Anhydrosis

Good for upper arm/shoulder surgery

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49
Q

Be careful doing intrascalene on patient with preexisting lung disease

A

Can hit phrenic leading to ipsilateral diaphragmatic paralysis which can lead to respiratory failure

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50
Q

MS patients have respiratory muscle weakness leading to

A

Aspiration, pneumonia, or acute respiratory failure

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51
Q

Loss of fetal heart rate variability is an early sign of

A

Fetal hypoxia

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52
Q

Magnesium potentiates the action of both

A

NMDB and depolarizing muscle relaxants

Give same dose of succ for intubation but lower dosage of rocuronium

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53
Q

Early decelerations occur

A

Simultaneously with uterine contractions

Late decelerations lag 10-30 seconds past uterine contractions

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54
Q

Treatment of choice for surgical bleeding prophylaxis in patients with VWD is

A

Desmopressin

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55
Q

Volume of aspiration and pH<2.5 major risk factors for

A

Pneumonitis

Increasing pH reduces risk of aspiration pneumonitis

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56
Q

After what week of pregnancy high risk of aspiration

A

18th

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57
Q

Delay emptying with opioids

A

Neuraxial and parenteral

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58
Q

Avoid hypotonic fluids on

A

Traumatic brain injury

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59
Q

Goal is to maintain CPP

A

50-70

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60
Q

CO causes endothelial cells and platelets for release

A

Nitric oxide

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61
Q

High NG output increases

A

SID and therefore causes alkalosis

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62
Q

Decrease SID

A

Lowers pH leading to acidosis

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63
Q

Children have slower redistribution of heat from core to

A

Periphery

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64
Q

Greatest heat loss comes from

A

Radiation

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65
Q

Shivering can increase oxygen consumption

A

A lot

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66
Q

C diff toxin enzyme immunoassay if concern for

A

C diff

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67
Q

Thyroid storm

A

Hyperthermia, tachycardia, agitation and confusion

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68
Q

CDH

A

Low tidal volume
PIP<25
Preductal sat want 90-95%

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69
Q

Low medial Thigh nerve root

A

L3

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70
Q

Best way to monitor RLN injury during thyroid surgery

A

EMG

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71
Q

Nasal CPAP has lowered BPD when compared to

A

Intubation and ventilation in neonates

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72
Q

Hypophosphatemia

A

Dysfunction of skeletal muscle

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73
Q

Hyperphos

A

Prolonged qt

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74
Q

Increased hemoglobin

A

More oxygen delivery

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75
Q

If someone is on high ventilatory support need another

A

Confirmatory death test bc apnea test inaccurate

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76
Q

SAH greater admission hgb decreased incidence of

A

Cerebral infarction

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77
Q

Vasospasm during SAH peaks at

A

5-7 days

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78
Q

Chronic renal insuffiency

A

Not an independent risk factor for compartment syndrome

Laparoscopic surgery is

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79
Q

Obturator nerve block goes between adductor

A

Longus and brevis

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80
Q

Obturator is not a branch of the

A

Femoral nerve

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81
Q

Quickest way to lower ICP transiently is a

A

Propofol bolus

Head up position

Diuretics maintain map drain csf

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82
Q

Bradycardia following carotid stent deployment

A

Carotid sinus baroceptor stimulation causing sympathetic inhibition

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83
Q

Carotid body senses

A

Pa02 and increases ventilation if hypoxia

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84
Q

Most effective treatment for refractory hypotension causes by AceI is

A

Norepinephrine not vasopressin

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85
Q

Massive venous air embolus cardiovascular collapse due to

A

RVOT obstruction resulting from air lock phenomenon in RV

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86
Q

Determining who is responsible for an event is not an endpoint of

A

Root cause analysis

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87
Q

Hyperbaric oxygen therapy works by

A

Increasing Pa02 and thus the amount of dissolved oxygen

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88
Q

Pyloromyotomy

A

Normalization of chloride most important metabolic change suggesting surgical optimization

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89
Q

Diaphragm is too anterior in intrascalene hitting phrenic so move needle more

A

Posterior

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90
Q

If sartoriius twitches during femoral block move needle more

A

Lateral

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91
Q

Most common congenital anomaly recognized at birth

A

Perimembranous VSD

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92
Q

PDA

A

Continuous machine like murmur at upper left sternal border

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93
Q

Organophosphate poisoning treat with

A

Atropine

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94
Q

After hemodialysis patients can get

A

Hypokalemia

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95
Q

ESRD patients have

A

Anemia not polycythemia

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96
Q

Supraclavicular block is next to the

A

Subclavian artery

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97
Q

Patient with chronic alcohol use have

A

Hypomagnesium

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98
Q

Glucose loading during TPN leads to

A

Hypophosphatemia

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99
Q

Patient should be monitored how long after raceemic epinephrine

A

4-5 hours at least

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100
Q

ESI has high success rate for providing

A

Short term analgesia for acute radicular pain due to disk herniation or spinal stenosis with nerve impingement

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101
Q

Epinephrine is not

A

Metabolized in the lungs or while in the pulmonary circulation

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102
Q

Would have skin pallor in lower

A

Extremities not flushing

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103
Q

Autonomic hyperreflexia shows up

A

2 weeks to 6 months after spinal cord injury

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104
Q

Do not use naloxone on neonatal resuscitation even if mother received large dose of

A

Morphine and is a drug user

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105
Q

Max lidocaine with epi dose is

A

7 mg/kg

1% lidocaine is 10mg per ml

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106
Q

Thoracic aortic aneurysms repair give

A

Fenoldopam which increases renal blood flow

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107
Q

Naturesis

A

Urine sodium excretion

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108
Q

Fenoldopam increases intraocular pressure so be careful using in a patient

A

With glaucoma or intraocular HTN

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109
Q

Radiation induced injury to thyroid via nuclear event can use

A

Potassium iodide

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110
Q

Peak and plateau pressure big difference usually due to

A

Kinking of endotracheal tube

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111
Q

Lupus anticoagulant prolongs activates PTT but not prothrombin time

A

PT

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112
Q

Factor 7 requires

A

Vitamin K for synthesis

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113
Q

Cryoprecipitate contains

A

Fibrinogen, fibronectin, VwF, and factors 8 and 13

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114
Q

Hypothermia decreases the metabolic rate of the

A

Brain.

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115
Q

During DHCA blood flow is

A

Non existent

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116
Q

Hypothermia is most important factor to decrease

A

Cerebral ischemia

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117
Q

Patients with hypoplastic left heart have Ductal dependent

A

From pda from RV to pulmonary artery

Pulmonary blood flow increase increases Qp to Qs then can get systemic hypoperfusion

If Fi02 goes up get reversal off hypoxia pulmonary vasoconstriction and decrease in PVR so pulmonary blood flow goes up resulting in systemic hypoperfusion

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118
Q

Decrease minute ventilation increases

A

PVR

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119
Q

Hypoplastic heart

A

First Norwood to Glenn to fontan

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120
Q

Bupivicaine highly protein bound so less

A

Placental transfer

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121
Q

If pKA higher than pH it will be

A

Ionized

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122
Q

2-4 days after being in altitude see

A

Bicarbonate loss in the CSF

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123
Q

Femoral and sciatic supply the knee

Can do knee replacement with

A

Lumbar epidural

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124
Q

Breast milk leads to higher gastric volumes than clears this is why it is

A

4 hours vs 2

NPO guidelines are based on gastric residual volumes

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125
Q

Cryoprecipitate does not contain factor

A

7

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126
Q

Neonates when cold use

A

Non shivering thermogenesis(oxidation of brown fat)

Increases glucose consumption and increases likelihood of hypoglycemia

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127
Q

Primary hyperaldosterone treat with

A

Spirnolactone

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128
Q

Transcutaneous pacers first activate the

A

Right ventricle similar to a VOO mode

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129
Q

Skeletal muscle can hurt when doing transcutaneous pacing so should give some

A

Sedation

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130
Q

Asymmetric LVH in

A

Hypertrophic cardiomyopathy

Avoid tachycardia, increased myocardial contractility, decreased diastolic filling time

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131
Q

Brain death can occur without

A

Herniation

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132
Q

Edema during brain injury becomes both

A

Vasogenic and cytotoxic

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133
Q

MG<72 months less likely for

A

Postop intubation

Also less likely if viral capacity is greater then 3

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134
Q

Redirect needle medial if

A

Foot eversion twitch is seen

Foot eversion twitch means you hit the common peroneal

Need to redirect needle more medial

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135
Q

Tibial nerve

A

Plantarflexion

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136
Q

.5 mg/kg oral versed for

A

Peds

Give 10 minutes before

Seperation anxiety starts at 6 mo

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137
Q

Suggamadex is ok on patients with

A

CHF

Not fda approved on pediatric patients
Patients with severe renal failure
Reversal of other nmbds besides roc or vec

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138
Q

Epiglottis management

A

Direct laryngoscopy under deep general anesthesia

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139
Q

Cyanide toxicity

A

Elevated anion gap

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140
Q

Cyanide toxicity

A

Oxygen is present so Pa02 will increase and oxygen can’t be utilized so Sv02 will increase

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141
Q

Chronic pelvic pain

A

Superior hypogastric

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142
Q

Methadone good for patients with

A

Chronic neuropathic pain

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143
Q

Why does maternal blood volume go up in pregnancy

A

Sodium retention via renin angiotensinogen system

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144
Q

Lumbar plexus block spares the

A

Sciatic nerve

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145
Q

LPB

A

Patient in lateral decubitus

Hit L4 transverse process

Then go cephalad until it slides past transverse process 2 cm deeper

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146
Q

Sciatic nerve

A

L4-S3

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147
Q

Patients with myasthenic syndrome

A

More sensitive to depolarizing and nondepolarizin blockers

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148
Q

Omphalocele

A

Chromosomal abnormalities

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149
Q

Cardiac resync therapy for

A

LVEf less then or equal to 35

IV conduction delay greater than 120msec

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150
Q

Cardiac myoxomas mainly found in the

A

Left atrium

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151
Q

Unstable patient with torsades

A

Unsynchronized cardioversion

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152
Q

Use a short duration stimulus when doing

A

Sciatic nerve block

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153
Q

Acute stretching of peritoneum can lead to

A

Asystole in laparoscopic procedures

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154
Q

Perforation ileofemoral axis during transcatheter aortic valve replacement

A

Hypotension and retroperitoneal extravasation

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155
Q

No lipid anabolism during

A

Stress response. You do see protein anabolism/catabolism

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156
Q

Most important for uterin blood flow is

A

Blood pressure

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157
Q

Zenker diverticulum absolute contraindication to

A

TEE placement

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158
Q

Don’t give what med with ECT

A

Lidocaine

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159
Q

Midazolam bioavailability

A

Intramuscular>intranasal>rectal>oral

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160
Q

Measuring oximetry in patient with lvad with

A

Oximitrey cerebral

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161
Q

Motor potentials

A

MEPs for anterior spinal cord

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162
Q

Patients with severe lung disease have least response to

A

Bronchodilator therapy

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163
Q

What nerve can get injured during repair of a PDA

A

Recurrent laryngeal nerve

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164
Q

Early onset adult ventilator pneumonia is likely due to

A

MSSA

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165
Q

Adding PEEP increases

A

FRC

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166
Q

Decreasing I to E ratio can help with

A

Breath stacking

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167
Q

Spinal cord stimulator directly affects

A

Dorsal horn of spinal cord and prevents conduction of chronic pain sensation

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168
Q

Spinothalamic tract the neurons cross to

A

Contra lateral side of spinal cord via anterior white commissure

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169
Q

Hypoalbumin will increase free fraction of benzos thus

A

Lower amounts can be given

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170
Q

Resistance to NMDBs starts 1 week following burn and peaks at

A

5-6 weeks

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171
Q

MEPs monitor

A

Anterior spinal cord

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172
Q

EEG monitors the

A

Cortex only

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173
Q

During hemodialysis large proteins don’t pass through so get increase in

A

Prealbumin levels

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174
Q

Factors 11 13 tpa and antithrombin 3

A

Decrease during pregnancy

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175
Q

Gabapentin is alpha 2 with

A

Very little respiratory of cardiac complications

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176
Q

Intrascalene May miss C8-T1 so don’t get

A

Ulnar

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177
Q

Best way to prevent post kidney transplant injury is

A

Good intravascular volume this is why we give mannitol before releasing vascular clamps

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178
Q

Cryoprecipitate contains

A

Factor 8 and fibrinogen(factor 1)

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179
Q

Methylergonive

A

Lasts 2-4 hours and given intramuscular

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180
Q

Hyperthyroidism

A

Decrease SVR

Looks like septic state

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181
Q

Insulin requirements go down after

A

Delivery

Leads to fetal macrosomia due to more glucose

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182
Q

Tachycardia

A

Less time in diastole and use more myocardial oxygen which is bad

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183
Q

Overriding aorta gets blood from

A

LV and RV

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184
Q

Avoid hypotension and increases in PVR

A

With primary P HTN

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185
Q

Chronic opioid use leads to

A

Decreased cortisol levels

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186
Q

Sodium deficit

A

140-serum sodium * total body water(.6)

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187
Q

Dantrolene contains

A

Mannitol

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188
Q

Oral versed

A

0.5 mg/kg in peds

Acts in 15-30 minutes

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189
Q

Salicylate poisoning

A

Metabolic acidosis and respiratory alkalosis

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190
Q

Trigger point injections

A

Do for painful limited range of motion

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191
Q

Oculocardiac reflex

A

Trigeminal and vagus nerve

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192
Q

Nd Yag laser passes

A

Through cornea without damaging it

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193
Q

Nd yag protective lens is

A

Green

C02 is clear plastic

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194
Q

Fetal tach
Maternal hyperglycemia
Maternal tachycardia

A

Terbutaline

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195
Q

Anterior cervical spine surgery can lead to vocal cord palsy due to endotracheal tube cuff on

A

RLN so need to readjust cuff once exposure happens

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196
Q

Trendelenberg decrease in

A

ERV and RV

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197
Q

Meperidine blunts

A

Shivering response to hypothermia which reduces total body oxygen demand

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198
Q

Goal temp

A

32 to 36 out of hospital cardiac arrest

Fasting cooling is endovascular cooling

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199
Q

Airway work of breathing in infants higher due to

A

Highly compliant chest wall

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200
Q

Catecholamine levels are much higher in

A

Geriatric patients

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201
Q

Myofascial pain syndrome

A

Trigger points in skeletal muscle often secondary to overuse and trauma

Will cause non dermatome pattern of radiation when palpated

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202
Q

Wait

A

6 hours after subq heparin to do epidural

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203
Q

In Addison’s disease you see

A

Hypercalcemia

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204
Q

SVT with wolf Parkinson’s white

A

Procainamide

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205
Q

Labetalol is more

A

Beta than alpha

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206
Q

iN0 can result in methemoglobinemia resulting in a

A

Left shift of the oxyhemoglobin curve and a decrease in the P50

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207
Q

High spinal blockade

A

Give fluid bolus and phenylephrine infusion but still endorses nausea what do we give

Atropine

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208
Q

Less pain

A

Less catecholamine release

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209
Q

Hyperparathyroidism can cause hyperchloremia

A

Increases renal bicarbonate loss, which may result in a normal anion gap metabolic acidosis

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210
Q

Multiple myeloma is associated with

A

Anemia not polycythemia

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211
Q

If in steep trendelenberg

A

Minimize laryngeal and facial edema

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212
Q

Avoid what drug in a pheo case

A

Ketamine

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213
Q

Remifentanyl is broken down by

A

Red blood cell and tissue esterases

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214
Q

Full term newborn

A

80-90 ml/kg

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215
Q

Premature blood volume

A

90-105 ml/kg

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216
Q

Tetanus acts by

A

Inhibition of neurotransmitter release from inhibitory neurons in the can

217
Q

Diptheria

A

Inhibition of elongation factor 2

218
Q

In MG leading factor for postop respiratory failure is

A

The inability to clear secretions and produce a strong cough

219
Q

P50 of fetal hemoglobin is

A

Lower bc it is shifted to the left

220
Q

Wife complex SVT

A

Synchronized cardioversion

221
Q

Retained epidural catheter best is to do a

222
Q

Cricoid pressure decreases

223
Q

Spinal anestgesia considered over general anesthesia in neonates or infants at risk for

A

Postop apnea

224
Q

Doubling the distance from a radiation source

A

Decreases exposure to one quarter of the original

225
Q

Sodium nitroprusside

A

Elevated mixed venous, SNP tachyphylaxis, and metabolic acidosis

226
Q

Imperforate anus often has

A

Neural tube defects

227
Q

Aortic cross clamp leads to

A

Increase in coronary blood flow

228
Q

Inhalation induction faster in

A

Pregnant patient due to increased minute ventilation, decreased FRC, decreased MAC requirement

229
Q

Hypocalcemia

A

Prolonged qt

230
Q

Aortic regurgitation

A

Nitroprusside

231
Q

TPN after one month will lead to

A

Increased PT time and will require vitamin K supplementation

232
Q

Don’t give inotropes to someone with hocm bc it will increase HR thus

A

Decrease in strike volume and myocardial perfusion

233
Q

Tourniquet leads to anaerobic metabolism and localized acidosis

A

When released leads to metabolic acidosis

234
Q

Cardiac surgery goes more with

235
Q

Maintain CPAP during

A

Inhalational ventilation is useful in a child with acute epiglottis

236
Q

Oligohydramimos does not lead to

A

Uterine rupture

237
Q

One side effect of terbutaline is

A

Hypokalemia and hyperglycemia

238
Q

Radiation exposure is inversely proportional to the

A

Square of the distance

239
Q

PGE1 common side effect is

240
Q

Elderly patients have an increased sensitivity to the

A

Synthetic opioids fentanyl, sufentanil and alfentanil

241
Q

Symptomatic severe hyponatremia one thing not to give is

A

Normal saline

Can give hypertonic and intubate if needed

242
Q

Troponin is more sensitive than CKMB for detecting

A

Myocardial injury

243
Q

Type 1 CPRS is due to a

A

Minor injury

244
Q

Prevent dilutional coagulopathy by giving

245
Q

Vasopressin increases

A

Cerebral perfusion pressure and cerebral oxygenation

246
Q

Dosing of single shot caudal epidural

247
Q

TEG

A

MA-> platelets
K value prolonged-> cryoprecipitate
R value prolonged-> FFP
Teardrop configuration-> antifibrinolytics

248
Q

Monopolist cautery is associated with increased potential for AICD

249
Q

In infants and children under 5 yo first sign of high or total spinal is

250
Q

As temperatures decrease gases become more

251
Q

Ulnar nerve is

A

Medial and up in axillary nerve block

252
Q

Neural tube defects go with

A

Folate deficiency

253
Q

Iv loading is least effective for preventing

A

Contrast induced nepropathy

254
Q

C Botulinum gram positive anaerobic treat with

A

Equine serum antitoxin

255
Q

Seizures can form from

A

Hyperglycemia

256
Q

Child Pugh score for liver disease does not take into account

A

Creatinine

257
Q

Morbidly obese patients

A

Increase in butyrylcholinesterase and extracellular fluid volume

258
Q

Use ideal body weight for

A

Rocuronium/vecuronium

259
Q

Total body weight

A

Maintenance infusion dose of propofol/ succinylcholine

260
Q

Ovarian arteries supply up to 15% of

A

Uterine blood flow

261
Q

Pituitary is located in

A

Sella turcica

Keep pt on steroids and give stress dose if pan hypopituitarism

262
Q

Hypersecretion of pituitary

A

ACTH results in Cushing syndrome
Excess prolactin leads to galactorrhea
Gigantism excess GH

Also get headache, papilledema, and visual disturbances with compression of optic nerve

263
Q

Oxytocin

A

Contraction of uterus

Promotes milk secretion

264
Q

Vasopressin works at

A

Collecting tubules

Constriction of vascular smooth muscle

265
Q

Diabetes insipidus

A

Central due to less vasopressin made by hypothalamus

Nephrogenic the hypothalamus is making it but renal tubules not using it

Very concentrated urine

Hypernatremia

266
Q

Diabetes insipidus

A

Urine osmol <300 and 24 hour urine volume>50 ml/kg

267
Q

Give DDAVP and isotonic crystalloid for

A

Nephrogenuc diabetes insipidus

268
Q

Small cell lung carcinoma leads to

269
Q

SIADH do

A

Fluid restriction

270
Q

SIADH

A

Fluid restriction can consider hypertonic saline and lasix

271
Q

Hyperglycemia is seen in

A

80% post cardiac surgery

272
Q

Glucose>126 more then 2 occasions is

273
Q

Type 1 diabetes

A

T cell mediated destruction of pancreatic beta cells

274
Q

Insulin

A

Stimulation of cellular uptake of glucose specifically in skeletal muscle, adipose, cardiac cells

275
Q

Not dependent on glucose

A

Brain liver immune cells

Suppression of gluconeogenesis and lipolysis

Leads to glycogen formation

276
Q

Glyburude glipizide leads to

A

Insulin secretion

277
Q

Met form in

A

Suppresses excessive hepatic glucose release

278
Q

Stop metformin 24 hours

A

Before surgery

279
Q

End organ complications DM

A

Atherosclerosis, increased incidence post op mi
Nepropathy
Neuropathies

280
Q

DM can lead to

A

Atlantoaxial instability making difficult laryngoscopy

281
Q

Hold oral hypoglycemics

A

24-48 hours preop

282
Q

Hypo is worse than

A

Hyperglycemia

Sugar above 200 leads to dehydration poor wound healing

283
Q

10-15 ropi for

A

Spinal

Should have inability for sustained leg left

284
Q

Epidural hematoma

A

Progressive loss of sensation or weakness in lower extremities bilaterally

Loss of bowel or bladder function

Severe acute onset severe back pain

More likely if female or hx of GI bleed

285
Q

Epidural hematoma treatment

A

If weak stop the epidural

Check how much you gave through epidural

Support MAP if hypotension

Get MRI and neurosurgery involved

Need to be fast

286
Q

Get laboratory tests

287
Q

Don’t pit catheter in

288
Q

Infection risk higher at day

A

7 and after so should take out

289
Q

Pencil point is better than

A

Cutting needle

290
Q

Get

291
Q

Propofol infusion

A

50 mcg/kg/min both respiratory depressant and bronchodilaton

Decrease tidal volume increase RR

Attenuates Vagal induced bronchoconstriction

292
Q

Propofol does not enhance

A

NMB

Peak effect at 100 seconds

Main loss after bolus dose is due to redistribution

293
Q

Administration of what is most effective for vasogenic cerebral edema

A

Steroids

Help lower ICP

Also use corticosteroids in treatment of pseudo tumor cerebri

294
Q

Loop diuretics like furosemide can

A

Help lower icp

295
Q

Decrease in ICP with mannitol is seen at about

A

30 minutes

296
Q

Inhaled volatile anesthetics will have increased pharmacodynamic effect in children with

A

Cerebral palsy

MAC requirement is much lower

Even lower if on antiepileptic

Thus you need less gas

297
Q

Increase in creatinine clearance occurs with pregnancy returns to prepregnant levels

A

8 to 12 weeks postpartum

298
Q

The duration of action of epidural bupi and ropi is not changed much by adding

A

Epi

Not true of peripheral blocks

299
Q

Carbohydrate load can precipitate attack of

A

Hypokalemic periodic paralysis

Carbohydrates broken into sugars which stimulate the pancreas to secrete insulin

300
Q

Psuedocholinesterase breaks down

A

Ester local anesthetics
Mivacurium
Succ

301
Q

Safest induction for this patient is

A

Iv prop and rocc with psuedohypertrophic cardiomyopathy

302
Q

Can’t give cpap to nonventilated lung if being

303
Q

Volatile anesthetics prolong the

A

QT in a dose dependent manner

304
Q

Less aldosterone leads to less

A

Water resorption

305
Q

Progesterone mediated smooth muscle relaxation decreases LES tone and impairs

A

Esophageal peristalsis and intestinal motility during pregnancy

306
Q

Placenta percreta leads to higher risk of

A

Hemorrhage bc it is more invasive

307
Q

A point of care glucose test strip is best way to see if fluid is

A

CSF or normal saline

308
Q

Glucose is present in CSF

A

40-70 but not in normal saline

Intrathecal catheter give ten times less dose

309
Q

Gradual decreases in fetal heart rate at or after the peak of uterine contractions

A

Are termed late decelerations

310
Q

Large volumes of chloroprocaine can cause

A

Muscle spasms

311
Q

Prone patients wiry ARDS helps with

A

Ventilation perfusion matching

312
Q

Sodium citrate increases gastric pH which is good in case patient

313
Q

Lidocaine decreases seizure duration so don’t use for

314
Q

High leak pressure replace with

A

Smaller tube

315
Q

Aortic arterial waveform has a less pronounced

A

Diastolic wave

316
Q

Postherpetic neuralgia

A

Age is big factor

317
Q

RSBI elevation is bad

A

Excess C02 what can help is using lower respiratory quotient like more lipid content in the TPN

318
Q

Lipids have lowest respiratory quotient at 0.7

A

Carbohydrates have highest at 1.0

319
Q

Neostigmine slows

A

HR and bronchoconstriction

320
Q

Tourniquet to 250 mmHg for

A

Bier block

Provides muscle relaxation also

Usually .5% lidocaine and don’t need epi

Easy rapid onset

Can give 25 to 50 ml of lidocaine

No bupi bc can cause LAST

321
Q

Local anesthetic goes through veins and gets nerves around it with

A

Bier block

322
Q

Tourniquet with Bier block can come off after

A

25 minutes

After 25 min get protein binding of LA and don’t release too soon can lead to LAST

323
Q

Local anesthetics have

A

Inherent vasodilation affects except cocaine

324
Q

Epi 1:200000

325
Q

R isomers of LA are more

326
Q

LAST due to too much local anesthetic

A

Systemically

Get CNS symptoms and hypotensivs

Give benzo

327
Q

20% lipid solution for LAST and use 100 ml bolus and infusion at 2.5 ml/kg

A

Lower dose epi(1 ug/kg)

328
Q

Succ goes through plasma and psuedocholinesterase can break succ down in

A

Plasma before it gets to neuromuscular junction

329
Q

Succ binds

A

Alpha units of nicotinic cholinergic receptors

330
Q

Psuedocholinesterase made in

331
Q

Dibucaine local anesthetic that usually inhibits psuedocholinesterase

A

Normal is 80%

If dibucaine of 20 it will prolong Succ duration a long time. Need to start sedation and give psuedocholinesterase through FFP

332
Q

Acetylcholinesterase inhibuted by

A

Neostigmine to increase Ach to stop neuromuscular blockade

333
Q

Physostigmine passes

334
Q

Organophosphate poisoning treatments

335
Q

Extra junctional nMJ stay open

A

Longer so get hyperkalemia

336
Q

Somatic nervous system bonds at

A

Nicotinic receptor

337
Q

Physostigmine does cross

A

BBB but neostigmine does not

338
Q

Pancuronium prolonged in patients with

339
Q

Suggmadex not approved for patients with

340
Q

Calcium leads to lots of AcH release and thus

A

Resistance to neuromuscular blocking agents

Inhaled agents potentiate both depolarizing and nondepolaring. Same with magnesium

341
Q

Opioid tolerance if need to keep giving

A

Bigger dose

342
Q

Opioid mu receptor itching treat with

A

Naloxone

Neuraxial not histamine mediated

343
Q

Neuraxial opioids act at

A

Substantial gelatinosa and periaqueductal gray

Mu2 has bad side effects

344
Q

100 mcg iv =

A

33 mcg epidural

345
Q

Emergence delirium decreased with

A

Midazolam when giving ketamine

346
Q

Propofol potentiates

A

Hypoxic pulmonary vasoconstriction

347
Q

Precedex

A

Inhibit NE release, decrease MAC, preserve respiratory drive

Decrease SVR and HR

Bolus leads to reflex HTN so give slow

348
Q

Moca need

A

250 CME credits need to be achieved over a 10 year cycle

349
Q

Intracranial rumors cause central diabetes insipidus

A

Treat with desmopressin

350
Q

Increased risk of epidural hematoma in patients with

A

Ankylosis spondylysis

351
Q

Upper extremity tourniquet should be inflated to at least 50 mm Hg above

A

SBP

Need at least 100 above systolic for lower extremity surgeries

352
Q

Tramadol and TCAs lower

A

Seizure threshold

353
Q

Tramadol is a

A

Partial opioid agonist

354
Q

Tension pneumocephalus can occur when nitrous oxides is used after a

A

Recent craniotomy

Delayed awakening can be seen and the diagnostic study of choice is a CT scan

355
Q

Aminoester reaction think

A

PABA

Aminoamide reaction think methylperaben

356
Q

Amniotic fluid embolism leads to

A

Intense pulmonary vasospasm

357
Q

Typical AVM consists of

A

Feeding arteries, a nidus, and draining veins

358
Q

Neuromonitoring during resection of AVM is important need to look at

A

Sensory and motor

359
Q

Parasympathetic nervous system predominates in

A

Newborns so atropine is best for bradycardia

360
Q

Myotonic dystrophy

A

Gastric atony

361
Q

Sucralfate does not change pH of

A

Gastric fluid

Helps with ventilator associated pneumonia

362
Q

A lumbar sympathetic block is very close to the

A

Psoas major

363
Q

PPV increases intrathoracic pressure which in turn increases

A

IVC pressure

364
Q

IABP is placed via the

A

Femoral artery

365
Q

Contraindications to IABP

A

Moderate to severe aortic disease

Severe peripheral vascular disease

366
Q

Tigecycline helps against

A

MRSA and gram negatives

367
Q

Inhaled volatile anesthetics will have increased

A

Pharmacodynamic effect in children with CP

368
Q

Pneumo will double in 10 minutes if giving

A

Nitrous oxide

Tension pneumocephalus after dural closure

369
Q

SF6

A

Avoid nitrous oxide for 4 weeks

370
Q

Cuff of ETT keep less then

A

30

Nitrous can increase this

371
Q

Just using volatile anesthetics causes

A

Arterial hypocarbia and alveolar ventilation

Apenic threshold is high

372
Q

Volatile anesthetics inhibit

373
Q

Des

A

1 Mac = 6% or 6% at sea level 6% of 760 is 46 mm Hg

374
Q

Isoflurane is a variable bypass

A

Vaporizer

1.2% x 760 mm Hg = 9

No % change needed at altitude

375
Q

ISO into Sevoflurane vaporizer

A

Sevo has lower vapor pressure

Then will get higher percentwge bc iso has higher vapor pressure

376
Q

Central compartment falls by 50% in infusion

A

Context sensitive half life

377
Q

Remifentanyl small

A

Context sensitive half life

378
Q

Phase 1 cyt 450

A

Oxidation reduction hydrolysis of lipophilic drugs

379
Q

Potency

A

Relative dose of two drugs

First drug on graph more potent

Efficacy intrinsic ability of a drug to produce clinical affect-which drug goes higher on the curve

380
Q

Anesthetics decrease

A

Amplitude and increase latency of SSEPs

381
Q

Ketamine and etomidate

A

Increase amplitude of signals

382
Q

NMBs are good for SSEPs

A

They eliminate background noise but can’t use when looking at MEPs

383
Q

SSEPs monitor

A

Posterior columns so can have anterior column injury without knowing it

384
Q

Warfarin inhibits synthesis of

A

Vit K dependent clotting factors

385
Q

LMWH

A

Selective inhibition of factor 10a

Monitor with anti factor 10a

Can’t monitor with PT/PTT

386
Q

Heparin acts on

A

AT3 and look at PTT

387
Q

Xarelto Apixiban

A

Factor 10a inhibitor

388
Q

Citrate binds

A

Calcium and is the anticoagulant in stored blood products

389
Q

Citrate metabolized to

A

C02 and then bicarbonate

390
Q

Citrate toxicity treatment give

A

IV calcium

391
Q

Thiazides work at

A

Distal convoluted tubule

392
Q

Acetazolamide blocks catholic anhydrase which is needed to block

A

Bicarbonate so you pee bicarbonate out and get acidosis

Acts at proximal convoluted tubule

393
Q

Furosemide acts at

A

Thick ascending limb

394
Q

Magnesium prolongs

A

NMDB and depolarizing blockers

Antagonism of NMDA receptors

395
Q

Magnesium side effect rapid

A

Flushing and hypotension

396
Q

1.5-2 is normal

A

Mag in plasma

Cardiac arrest at 20

ECG changes at 5-10

Loss of deep tendon reflexes at 10

397
Q

Inhaled nitric oxide

A

Selective dilation of pulmonary vasculature

CGMP mediated

398
Q

Prostaglandins dilate

A

Afferent arteriole

COX leads to constriction of afferent arteriole

399
Q

Dig increases intracellular

A

Calcium

Low K and Mg

Get short qt interval and st segment depression

400
Q

Organophosphate poisoning treatment

A

Atropine

Competitive muscarinic blocker

401
Q

Prophylaxis for nerve gas

A

Pyridostigmine

But atropine is the acute treatment which blocks Ach effect

402
Q

Tramadol

A

Mu receptor agonist

Increases serotonin

Reuptake of norepinephrine

Avoid with MAOis

Tramadol is a prodrug and needs CYP2D6 to be activated

403
Q

TEE most sensitive for detecting

A

Myocardial ischemia

PCWP is least specific

404
Q

Give precurization dose

A

10% of ED95 dose it is 0.03 mg/kg

405
Q

Phenylephrine causes increased

A

Afterload and not good for patients with MR

406
Q

IO line

A

Proximal humerus
Proximal tibia
Distal Tibia
Sternum

407
Q

Biggest risk factor for meconium passage is

A

Later gestational age

408
Q

Maternal steroids should be given when birth is anticipated between

A

24 and 34 weeks gestation, when fetal lungs are immature

409
Q

Prazosin

A

Selective alpha 1 receptor antagonist

410
Q

Max Epi dose tumescent lidocaine is

A

0.055 mg/kg

411
Q

Don’t give what medication to children following tonsillectomy

412
Q

Barbiturate infusion

A

Decreases CMR02 and thus increases jugular mixed venous

413
Q

Oliguria

414
Q

Sympathetic activation leads to

A

Decrease urine output

415
Q

Newborn lung is less compliant than

416
Q

Gilbert’s disease most increases risk of

A

Jaundice after multiple transfusions of pRBCs

417
Q

Gilbert’s defective enzyme is

A

Bilirubin glucuronyl transfersase

418
Q

Cyclosporine can cause

A

Nephrotoxicity not pulmonary toxicity

419
Q

Difficulty swallowing due to esophageal atresia in patients with

420
Q

Succ hyperkalemic arrest in patients with muscular dystrophies is due to

A

Rhabdomyolysis

421
Q

Only do LP

A

After imaging completed for HA

422
Q

Greater thermistor temperature change in

A

Low cardiac output states

Less temperature change if high cardiac output bc less time to mix of injectate to blood

423
Q

TR will lower

A

Cardiac output measure by thermodilution

Takes longer for injectate to reach pulmonary artery where it is measured so will show up as lower CO

424
Q

T12-L1 and S2-S4 is

A

Secondary stage of labor

425
Q

Fat embolism don’t give

426
Q

Nitrous oxide does not cause

A

Uterine relaxation

427
Q

Pidendal block for

A

Stage 2

Can also do remi infusion or inhalational induction with nitrous

428
Q

Hepatopulmonary syndrome improves with

A

Sitting

A-a gradient increased

429
Q

Heart rate generation is dependent on the

A

Donor atrium

430
Q

Transplanted heart has

A

Less variability and higher intrinsic HR(eating between 90 to 110

431
Q

Toxic methemoglobinemia

A

IV methylene blue

432
Q

Ketamine less desirable for patient with

A

Coronary artery disease it may potentiate the sympathetic surge seen with ECT resulting in increased myocardial o2 demand and potential ischemia

433
Q

Acute herpes zoster most common dermatome distribution is

434
Q

Alkalization of urine using

A

Carbonic anhydrase inhibitor

435
Q

Don’t use benzos for

A

Acute mountain sickness

436
Q

LV is perfused during

437
Q

Methadone is hard to

438
Q

B2 agonists like ritodrine

A

Relax uterine contractions and increase uterine blood flow

439
Q

To help with thoracic aortic aneurysm stent place heart in

A

Transient cardiac asystole

440
Q

Superior laryngeal nerve

A

Voice gets tired when talking more

441
Q

LV is primarily perfused during diastole so

A

Longer systolic time is bad bc it leads to less diastolic time

442
Q

TPN is most associated with

A

Thrombophlebitis and infection

443
Q

Safe anesthesia agents in MH include

A

Nitrous oxide

Can’t use succ or volatile anesthetics

444
Q

Sodium bicarbonate needed for normal pH formula is

A

0.2 x patient weight in kg x base deficit

445
Q

Myotonic dystrophy you don’t need

446
Q

Persistive vegetative state patients can

447
Q

Norepinephrine should not be administered IM

A

Can cause local ischemia and tissue necrosis

448
Q

Ketamine

A

Sch 3 drug

449
Q

Sch 1 drugs

A

Very high abuse potential such as cannibis

450
Q

Most common defect associated with TEF is

A

Congenital heart defects

451
Q

Glycopyrolate is poorly transferred across

452
Q

Hypoplastic left heart associated with

453
Q

2% lidocaine can undergo

A

Ion trapping and potentially accumulate in the fetus causing fetal acidosis

454
Q

Less functional Ach receptors with

A

Myasthenia gravis

Need to give more Succ

455
Q

Static compliance measures the lung at a

A

Fixed volume

456
Q

Renin release is increased in

A

Cirrhotic patients

457
Q

Treatment of methemoglobinemia in G6pd deficiency is

A

Ascorbic acid not methylene blue

458
Q

Oligohydramimos is not associated with

A

Placental abruption

459
Q

Impaired platelet aggregation makes hemostasis hard in

A

Dialysis patients

460
Q

Phenylephrine increases

A

Afterload thus decreasing cardiac output leading to lower mixed venous

461
Q

Heparin resistance if

A

AT3 levels low platelet count above 300000, preop heparin, use of low molecular weight heparin, age>65

462
Q

SIADH patients are

A

Euvolemic or hypervklemic

463
Q

Beat to beat variability is normal

A

Fetal heart rate intermittently varies 10 beats per minute from baseline

464
Q

Late decel

A

Occurs after onset of uterine contraction

465
Q

TURP main complication is

A

Hypothermia

466
Q

Alveolar hypoxia is induced due to

A

Decreased atmospheric pressure resulting in diffuse hypoxic pulmonary vasoconstriction

467
Q

Walking uphill or squatting helps with

A

Spinal stenosis

468
Q

Compartment syndrome occurs when tissue perfusion exceeds

A

Local perfusion pressure

469
Q

Idiopathic intracranial HTN

A

Can put in catheter intrathecal and drain CSF

470
Q

CSF volume is higher on a ml/kg basis in children than in

471
Q

Cyanide toxicity due to fire first line treatment is

A

Hydroxycobalamin

472
Q

LV did tension coming off bypass and lateral wall hypokinesis due to

A

Embolus in left coronary artery

473
Q

For a turp need to also block

474
Q

Most appropriate therapy to reduce rate of vasospasm following clipping of a ruptured berry aneurysm is

A

Nimodipine

475
Q

Terbutaline can cause

A

Hyperglycemia

476
Q

Anterior mediastinal mass cause compression of the

A

Tracheobromchial tree

477
Q

If minute ventilation exceeds fresh gas flow

A

H in j k UK mi my my

Hu mlol
I’m

K kit Lu

478
Q

If patient is anticoagulated can’t do

A

Neuraxial anesthesia

479
Q

Always start hydration first before giving insulin in a patient with

480
Q

Decreasing pKa and higher pH means more ionized so works faster

A

Chloroprocaine is rapid due to high concentration

481
Q

Allalization speeds onset of local

A

Anesthetic. An abscess is acidic so putting local in it won’t work well

482
Q

Epi 1:200000

483
Q

Epi prolongs shorter acting LAs like

484
Q

Ester

485
Q

IV>tracheal>intercostal>caudal>paracervical to

486
Q

Suppress local anesthetic seizure with

487
Q

Toxicity of local anesthetic potentiate by

A

Acidosis hypercarbia pregnancy

488
Q

Cocaine to city treat with

A

Nitroglycerin(don’t give beta blockers first)

489
Q

LA toxicity

A

Hyperventilate
Lipid emulsion
Low dose Epi
No vasopressin

490
Q

Methemoglobinemia

A

Oxidized iron from Fe2+ to Fe3+ doesn’t bind Hgb

491
Q

EMLA cream is

A

Lidocaine and prilocaine

Can cause methemoglobinemia

492
Q

Peak lidocaine levels occur

A

12-14 hours after injection in tumescent lidocaine injection

493
Q

Local anesthetics are weak bases attached to

A

Alpha 1 acid glycoprotein

494
Q

2 alpha subunits is where

495
Q

Acetylcholinesterase is located in

A

Post junctional receptor

496
Q

Succ increases

497
Q

Succ phase 2 similar to

A

NMDB block

498
Q

Succ can give in

A

Cerebral palsy and renal failure

499
Q

Succ induced hyperkalemia in

A

Burns and patients with muscular dystrophy can release potassium with rhabdomyolysis

500
Q

Panc prolonged most with

A

Renal failure

501
Q

Succ binds

A

Post junctional receptors

502
Q

Hypokalemic periodic paralysis avoid

A

Hypothermia, stress, carbohydrate loads(more insulin release) beta agonists

503
Q

Avoid Succ in

A

Hyperkalemic periodic paralysis

504
Q

Pancuronium can increase

505
Q

Succ can cause

A

Bradycardia in neonates and infants

506
Q

Neostigmine inhibits

A

Psuedocholinesterase as well so Succ May be needed

507
Q

Blocks exocytosis of pre synaptic Ach

A

Botulism and tetanus

508
Q

Atropine for too much

A

Neostigmine leading to SLUDGE

509
Q

TIVA and nitrous don’t prolong

A

Neuromuscular blockade do have to give more

510
Q

Mg increases

A

ND and depolarizing NMBs

And calcium channel blockers
Lithium clindamycin aminoglycosides

511
Q

Adductor Pollicis is last to recover from

A

Nmdb so if this is good we are good

512
Q

Orbicularis oculi

A

Block is more rapid and recovery occurs sooner

513
Q

TOF>.9 is

514
Q

Double burst easier to detect fade bc only

515
Q

Residual neuromuscular blockade fade is due to

A

Residual paralysis

516
Q

Desflurane potentiate

A

NMDB the most

517
Q

Femoral

A

Ventral Rami L2-4

518
Q

If sartorius stimulated during femoral nerve block redirect

A

Needle deeper and lateral

519
Q

NAV

A

Order of structures

520
Q

Saphenous from ventral Rani

A

L3-L4

Sensory only

521
Q

Sciatic nerve block

A

Ventral Rami L4-5 and S1-S3

522
Q

For sciatic block want to see

A

Plantar flexion of ankle/foot

523
Q

2% lidocaine

524
Q

Uterine rupture

A

Fetal bradycardia

Diffuse pain even with epidural

525
Q

1/10 for

A

Intrathecal dose

1cc .2% ropi

526
Q

Skin test gold standard to diagnose

A

Anaphylaxis

527
Q

DLCO is increased in

528
Q

What volatile anesthetic fucks up SSEPs the most

A

Isoflurane

529
Q

3 to 1

A

Iv to oral morphine

530
Q

Continue pyridostigmine

A

On day of surgery

531
Q

For mediastinal mass

A

Two pulse ox

Right inonimste artery compression check with right radial artery

532
Q

Lose etc02 during mediastinal mass

A

First hand ventilate, if can’t then made compression, try to pass rigid brinchoscope past obstruction then move in lateral or prone, if not open chest and CP bypass

533
Q

Right arterial line tracing diminished during mediastinoscopy

A

Compression of Inonimate artery causing artificially low bp readings

534
Q

Complication of mediatinoscopy is

A

Recurrent laryngeal nerve injury

Leads to hoarseness

535
Q

Myasthenia gravis symptoms are usually

536
Q

AOrtic dissection could have massive

A

Blood loss

537
Q

Tachycardia is a side effect of

A

Nitroglycerin

538
Q

For aortic dissection if BP 75/45 in lower extremity

A

Attempt to increase perfusion pressure distal to cross clamp by placing shunt

539
Q

If bp drops after cross clamp and ST changes

A

Tell surgeon to immediately reapply clamp. Once BP improves slowly remove clamp while adding infusion of norepinephrine to increase SVR

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