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Anesthesia Oral Boards > UBP book 3 > Flashcards

UBP book 3 Flashcards

1
Q

Aortic stenosis transvalvular gradients

A

<25: mild
25-40: moderate
40-50: severe
> 50: critical

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2
Q

Aortic stenosis, valve areas

A

Normal 2.5 to 4
Mild 1.5 to 2
Moderate 1 to 1.5
Severe .7 to 1
Critical less than 0.7

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3
Q

Aortic stenosis, velocity of aortic jets in meters per second

A

Mild less than three
Moderate 3 to 4
Severe 4 to 4.5
Critical greater than 4.5

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4
Q

When do you need prophylaxis for bacterial endocarditis?

A
  • prosthetic, cardiac valve or prosthetic material used for valve repair
    -Previous occurrence of infectious endocarditis
    -Unrepaired cyanotic congenital heart disease
    -Six month postoperatively following repaired congenital heart defect using prosthetic material
    -Repaired congenital heart disease with residual defect
    -Cardiac transplant, who develops valvulopathy
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5
Q

Went to discontinue enoxaparin to neuraxial

A

24 hours

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6
Q

Spinal and epidural, anesthesia,
In multiple sclerosis

A

Can be associated with an exacerbation of MS
-More significant and spinal and epidural, using high concentrations of local anesthetic, less likely with dilute solutions for labor pain control

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7
Q

When do you need to start taking a platelet level with heparin?

A

After four days for risk of heparin induced thrombocytopenia

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8
Q

How long to hold subq heparin before spinal

A

4-6 hours or normal PTT

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9
Q

How long to hold subcutaneous heparin with three times a day dosing at higher doses before spinal

A

12 Hours and normal PTT

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10
Q

Can you use protamine to reverse, low molecular weight heparin?

A

No

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11
Q

Asthmatic patients way to decrease ventricular rate

A

Diltiazem

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12
Q

symptoms of PDPH

A

-frontal-occipital HA
-Dec pain w/ laying flat
-N/V
-neck stiffness
-photophobia
-diplopia (stretching on abducens n)
-tinnitus, hearing loss
(Sz rare from cerebral vasospasm)

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13
Q

Aspiration ppx in pregnancy

A

Metochlopramide
Famotidine
Sodium citrate

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14
Q

Why do we give stress dose steroids?

A

Suppression of hypothalamic-pituitary adrenal axis with exogenous steroids -> cannot produce adequate cortisol under stress conditions

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15
Q

Symptoms of Addisonian crisis

A

(Life-threatening low cortisol)
-fever
-abd pain
-dehydration
-N/V
-hypoglycemia (cortisol promotes gluconeogenesis)
-acidosis
-hyperK, hypoNa (Dec Aldo)
-circulatory collapse
-depressed mentation

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16
Q

stress dose steroids

A

100mg IV hydrocoritsone preop
100mg q8h on day of surgery

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17
Q

epidural ok for c/s in pt w/ MS?

A

-acknowledge risk of exacerbating MS symptoms -> however lower with short duration of action local anesthetics
-benefits of avoiding manipulating difficult airway, red risk of aspiration, superior post op analgesia

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18
Q

succinylcholine and MS

A

AVOID -> likely to have chronic skeletal muscle weakness -> run the risk of hyperK

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19
Q

emergent c/s needs GA, severe AS induction?

A

-difficult airway equipment available
-premeds: asp ppx, albuterol, fluids for AS, consider esmolol to avoid tachycardia w/ laryngoscopy
-cadioversion pads (need atrial kick and sinus) and phenylephrine
-L uterine displacement
-etomidate and narcotics -> rapidly secure airway and tell neonatal team about narcotics
-a line as soon as possible if not present yet
**assess if can get succ w/ comorbidities

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20
Q

ST changes in aortic stenosis after induction, what to do?

A

-give vasoconstrictor if concern is dec in preload or afterload causing ischemia -> need to inc coronary perfusion
-if concern is LV function and need dec in afterload -> give nicardipine (causes arterial dilation with minimal venodilation -> won’t impact preload)

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21
Q

large PPH, what to do?

A

-verify pt receiving pitocin
-FiO2 100%, ensure hemodyanimc stability -> likely req phenyleprhine
-notify blood bank and call for pRBCs
-inc oxytocin
-methergine (semisynthetic ergot alkaloid), hemabate PG F2alpha analogue), or misoprostol (PG E1 analogue)
-OB: uterine massage -> IU balloon -> compression sutures -> ligate arteries -> hysterectomy

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22
Q

CI for methergine

A

HTN
coronary artery issues (causes coronary artery vasoconstriction)

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23
Q

pregnant pt w/ chorio and MS and ASA, 5 hours after pulling epidural, b/l leg weakness and back pain, ddx?

A

-bactermia from chorio
-epidural/spinal hematoma
-residual epidural blockade
-tissue damage w/ needle instrumentation
-relapsing MS

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24
Q

signs/symp w/ epidural/spinal hematoma

A

back pain or pressure: severe and unrelenting
-bowel/bladder dysfunction (urinary retention)
-radicular pain (shoots down into legs)
-sensory deficits

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25
Q

sign/symp w/ MS relapse

A

paresthesias
-weakness
-sensory deficits
-urinary incontinence, bowel retention
-visual and gait disturbances
-autonimic dysfunction
-vision changes

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26
Q

post c/s MS was on AC w/ epidural catheter, urinary incontinence w/ back pain and weakness, what to do?

A

-likely MS relapse HOWEVER spinal/epidural hemaotoma needs to be ruled out first
-examine pt -> determine if weakness progressive or recessive -> MRI and c/s neurosurgery
-intervention needs to occur w/i 6-12 hrs to avoid irreversible SC injruy

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27
Q

restart therapeutic enoxaparin after c/s?

A

-24 hours following surgery
AND
-at least 2 hours after epidural catheter removed
*acknowledge risk of DVT/PE v bleeding from surgery or epidural/spinal hematoma

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28
Q

post c/s dyspneic ddx w/ MS, AS, PEC?

A

-pulm thromboembolism, DVT, AFE
-HF
MI
bronchospasm
TPTX (PTx after central line)
pulm edema (PEC, AS)
aspiration
MS

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29
Q

PE immediately postop, tx?

A

-100% FiO2
-give inotropes and fluids using CVP, a line, TEE monitors -> pulm vasodilators (nitric oxide, milrinone [PDE inh])
-intubate and mechanically ventilate if needed
-avoid AC due to stop -> vena-cava filter, or pulm embolectomy

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30
Q

how does inhaled nitric oxide work?

A

inc cGMP -> dec in intracellular calcium and smooth m relaxation

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31
Q

2 days post c/s HA, ddx?

A

-tension HA
-migraines
-PDPH
-lactation HA
-PNEUMOCEPHALUS (if LOR done w/ air)
-PEC?
-SAH, SDH

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32
Q

PDPH, tx?

A

hydration
caffiene
abd binder (inc intraabd pressure)
pain control

**consider epidural blood patch, but look at AC likely postop

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33
Q

MVA cant move extremities, SOB, ddx?

A

-cervical spine injury above C6
-PTX
-pulm edema (tamponade, MI, PE, neurogenic pulm edema)
-PE (fat emoblism 2/2 long bone fx)

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34
Q

what is neurogenic pulm edema

A

head injury or cervical spinen injury -?> sympathetic activation -> systemic vasoconstriction -> dec LV compliance and inc LA pressure -> pulm edema

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35
Q

cardioaccelerator fibers

A

T1-T4

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36
Q

cervical SC injury, concerns?

A

-resp dysfunction (loss of diaphragmatic fxn)
-hypoTN (loss of sympathetic vascular tone and cardioaccelerator fibers
-pulm aspriation (impaired airway reflexes)
-thermal regulation (loss of vasoconstriction and temp sensation)
-arrhythmias (autonomic dysfunction)
-end organ ischemia (inc ICP, CAD< hypoTN, acidosis, hypoxia, anemia)
-difficult airway

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37
Q

hyperventilate w/ SC injury or TBI?

A

Nope
-head trauma and SC trauma -> dec SCBF and CBF 1st 24 hours -> concernerd for ischemia

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38
Q

R on T phenomenon

A

When a QRS from a PVC lands on a T wave during the refractory period
-or a shock is delivered on a T wave
**can cause V fib or V tach

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39
Q

When are PVCs a problem?

A

-frequent: more than 3 per minute
-occur in runs of 3 or more
-R on T pneomenon
-> all lead to inc risk of V tach or V fib

**more than 5-6 per minute -> inc periop morbidity

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40
Q

What causes PVCs?

A

hypoxemia
-MI, hypoK, hypoMg
-symp acctivation
-mechanical irritation (Central line)
-d/c drugs that prolong QT
-ensure defibrilator

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41
Q

What to do if pt hemodynamically unstable or symptomatic w/ PVCs?

A

overdrive pacing
antriarrhythmic: amiodarone, a beta blocker

**if unstable -> cardiovert, stable -> amio

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42
Q

Spinal shock

A

can occur following acute SC injury
-flaccid paralysis, paralytic ileus
-loss of sensation, spinal reflexes, symp vasomotor TONE!
-no otemp regulation below injury
-can get loss of diaphragmatic function, IC and m function (can’t clear pulm secretions), loss of cardioaccelerator fibers

**can last 1-3 weeks -> risk of resp dysfxn, hemodynamic instability, aspiration, DVT/PE, hypothermia

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43
Q

How long for inc in extrajunctional ACh receptors after SC injury?

A

24-48 hours

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44
Q

What to do if whole bottle of volatile spills on floor

A

-risk of significant expsoure of OR personnel
-suction spilled volatile into plastic container -> seal and labor -> transport to appropriate waste disposal site
-verify pt secured, ensure adequate sedation and NMB -> prepare for transport into different room

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45
Q

SC injury to C5 w/ CAD and DES -> when can have elective surgery?

A

-resolution of hemodyanmic stability 2/2 spinal scord shock?
-plavix can be safely d/c ideally 6 months after DES

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46
Q

What level does autonomic hyperreflexia occur above?

A

T7

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47
Q

O2 supply compromised what to do?

A

**concern for giving hypoxic gas mixture
-switch to backup O2 cylinders
-disconnect main pipeline supply
-hand ventilate w/ low gas flows -> if pneumatically driven vent uses more O2
-ask for additional E-cylinders

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48
Q

Estimating O2 E-cylinder supply time

A

O2 cylinder pressure (psig)/ (200 x oxygen flow rate in L/min)

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49
Q

Autonomic hyperreflexia, what to do?

A

-surgeon to stop
-deepen anesthesia
-vasodilator: NG, nitroprusside
-bladder empty
-a line
-monitor for complications: cerebral, retinal, SAH, sz, MI, dysrhtyhmias, pulm edema

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50
Q

Pathophys of autonomic hyperreflexia

A

pain below level of SC injury -> reflex sympathetic d/c -> not modulated by inhibitory impuses from CNS -> unopposed symp d/c -> vasoconstriction below level of lesion, and vasodilationn above lesion where can stimulate carotid sinus receptors -> reflex bradycardia

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51
Q

normal closure ducturs arteriosus

A

ventilation -> arterial O2 levels inc and PVR dec
-dec in PVR leads to a L to R PDA shunt -> exposure to blood with higher O2 count
-decrease in PG w/ separation from placenta -> closure

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52
Q

reasons PDA didn’t close

A

hypoxia at birth (no dec in PVR)
-prematurity: poorly contractile muscular layer in ductus artioersus -> didn’t appropriately contract w/ dec PG and inc in O2)

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53
Q

respiratory distress syndrome of the newborn reason?

A

premature infants and insufficient surfactant -> widespread atelectasis -> intrapulm shuting -> hypoxemia and acidosis

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54
Q

sympatoms of respiratory distress syndrome of the newborn

A

hypoxemia
acidosis
nasal flaring
accessory muscle use while breathing
tachypnea, tachycardia
b/l rales
cyanosis

ground glass infiltrates b/l on CXR

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55
Q

how to minimize resp distress syndrome of newborn

A

maternal steroids 24-34 weeks if expect born before 35 weeks
exogenous surfactant to newborn

56
Q

Indomethacin MOA

A

PG synthetase inhibitors -> dec PG in PDA

57
Q

SE from indomethacin

A

thrombocytopenia
hypoNa
and reduced renal blood flow, mesenteric BF, and CBF

58
Q

glucosuria in premature infants

A

-infants < 34 weeks have issures w/ renal tubular reabsorption of glucose
-less concerning if < 34 weeks, if > 34 weeks considerning

59
Q

concerns w/ prematurity

A

-hypoglycemia
-retinopathy of prematurity
-intraventricular hemorrhage
-postop apnea
-hypothermia

60
Q

PDA ligation complications

A

-RLN injury
-phrenic n injury
-thoracic duct injury
-injury to major vessels
-HTN (volume goes forward s/p ligation)
-reopening of ductus

61
Q

w/ PDA closure, where to monitor BP?

A

R arm -> incase of rupture would need to to clamp L subclavian artery

62
Q

w/ PDA closure, where to monitor pulse ox?

A

R upper extremity and lower extremity -> pre and post ductal readings

63
Q

PaO2 goal to avoid retinopathy of prematurity

A

50-80
SpO2 goal 87-94%

64
Q

RF for retinopathy of prematurity

A

-hyperoxia
-prematurity < 32 wweeks
-low birth weight < 1000g
-hypoTN
-sepsis
-RBC transfusions
-cyanotic congential heart dx
-resp distress syndrome
-intraventircular hemorrhage
-material diabetes
mechanical ventilation

65
Q

maintain anesthesia for neonates

A

fentanyl and muscle relaxant (rocuronium)

66
Q

how to monitor blood loss in neonate

A

weigh sponges, laps, etc. to estimate -> replace 3:1 w/ crystalloid or colloid/prbcs as indicated

67
Q

average blood volume premature neonates

A

90-100 cc/kg

68
Q

average blood volume pregnant women

A

90cc/kg

69
Q

average blood volume full term neonates

A

80-90 cc/kg

70
Q

average blood volume hcild 3-12 months old

A

70-80 cc/kg

71
Q

average blood volume child > 1 yaer

A

70-75 cc/kg

72
Q

average blood volume obese child

A

60-65 cc/kg

73
Q

average blood volume adult man

A

75 cc/kg

74
Q

average blood volume adult women

A

65 cc/kg

75
Q

dissection of PDA -> O2 sat drops and HR drops, what to do?

A

-FiO2 100%, manually ventilate
-verify accuracy of monitors
-eval EKG, airway pressures and TV
-dissection w/ pressure on lung van inc PVR -> R to L shunting -> ask surgery to relax traction on lung
-assesss blood loss and volume status to correct
-give atropine if continued bradycardia
-adjust insp pressures and FiO2 to optimize oxygenation and ventilation

76
Q

post PDA ligation neonate is hypertensive, ddx?

A

-ligation of PDA (BF that was prev going to lungs going systemically)
-inaccurate (wrong sized BP cuff)
-inadequate pain control
-agitation
-hypervolemia
-hypercarbia
-hypoxemia
-bladder distention
-possible inc ICP (risk of intraventricular hemorrhage)

77
Q

how do infants maintain heat

A

nonshivering thermogenesis
-symp stimulation -> NE release -> metabolism of brown fat -> inc O2 consumption and heat production

78
Q

Neonatal sz ddx?

A

intraventricular hemmorhage
hypoCa, hypoMg
hypoglycemia
cerebral edema
hypoxic-ischemic encephalopathy
sepsis

79
Q

neonatal sz what to do?

A

-check ETT placement, auscultate
-review monitors and vent settings -> adequate O2 and ventilation
-check EKG and BP
-give benzos to stop
-order lytes, tell neonatologist, consider neuro c/s

80
Q

SOB w/ lung cancer

A

mass compression of heart or great vessels
-SVC syndrome
-post-obstructive PNA
-V/Q mismatch
-cardiac or pulm dx (COPD)
-Lambert-Eaton

81
Q

SOB w/ SVC syndrome

A

obstruction of venous draiinage -> mucosal edema and venous engorgement of airways -> dyspnea, orthopnea, and coughing

82
Q

Common paraneoplastic syndromes assoc w/ cancer

A

-PTHrP tumor release
-SIADH
-Cushings Syndrome
-Lambert Eaton Myasthenic Syndrome (small cell lung cancer)
-Carcinoid Syndrome

83
Q

Paraneoplastic PTHrP symptoms?

A

muscle weakness, cardiac arrhythmias, vomiting, renal failure
**HyperCalcemia

84
Q

paraneoplastic cushings syndrome symptoms?

A

inc ACTH or CRH (corticotropin releasing hormone, adrenocorticotropic hormone)
-hypoK, alkalosis, HTN, psychosis

85
Q

Lambert Eaton symptoms

A

proximal weakness of lower rextremities (cna progress to upper extremities)
-autonomic dysfunction: dry mouth, impotence, constipation, orthostatic hypoTN

86
Q

Treatment of lambert eaton

A

-cancer therapy
-plasma exchange, IVIG
-prednisone
-3,4-diaminopyridine
-pyridostigmine (dec degradation of ACh)

87
Q

Lab tests for SIADH

A

-normal total body sodium
-increase urine osmolality
-inc urinary sodium concentration
-normovolemia

88
Q

Sodium level, when to delay case

A

Na < 130 -> assoc w/ inc risk of cerebral edema
-figure out why and treat appropriately
-discuss risks/benefits w/ surgery, acknowledge importance of timely surgery

89
Q

a line and pulse ox in mediastinoscopy

A

R arm! b/c likely to have brachiocephalic artery compression w/ mediastinoscopy -> alert to compression

**especially important if pt has cerebral disease

90
Q

Contraindictions to mediastinoscopy

A

-severe tracheal deviation
-cerebrovascular disease
-severe cervical spine dx w/ limited neck extension
-previous chest radiotherapy
-thoracic aortic aneurysm

91
Q

Concerns for HTN intraop

A

BP lability
and R shift of cerebral autoregulation curve -> inc risk of cerebral ischemia
-poorly controlled HTN -> introap end organ ischemia (MI, stroke), arrhythmias, CHF, hypoTN, HTNq

92
Q

HTN and elective surgery

A

DELAY 6-8 weeks if:
-systolic BP > 180, diastolic > 110
-HTN w/ concomitant end organ damage
-cardiac surgery, carotid surgery, or pheo resection **should be well controlled to limit postop M&M)

93
Q

Causes of HTN

A

-CKD
-renovascsular dx
-chronic steroids (Cushings)
-OSA
-drugs (cocaine, amphetamines)
-alcohol abuse
-obesity
-thryoid/parathyroid dx
-pheo
-aortic coarctation

94
Q

opacification of upper extremity collateral veins on CT, dx?

A

SVC syndrome

95
Q

SVC syndrome symptoms

A

JVD
coughing/hoarseness
SOB
opacifications of upper extremity collateral vwins on CT
HA
facial/neck/upper limb edema
chest pain
dysphagia
orthopnea
visual changes
mental confusion

96
Q

Intraop concerns for SVC sydnrome

A

-difficult intubation airway edema
-unreliable drug delibery through IV in upper extremities
-potential for massive hemorrhage if damage to vessels
-compromised cerebral perfusion (impaired drainage of cerebral veins -> inc cerebral venous pressure -> inc ICP and impaired perfusion)
-inc risk of postop resp complications (airway edema or mass compression)

97
Q

SVC syndrome, what to do intraop?

A

-difficult airway equpiment, minimize airway manipulation
-2 large PIV catheters (1 on lower extremity)
-T&S, T&C blood
-head up position to facilitate cerebral venous drainage -> avoid inc ICP
-cautious fluids -> too much engorgement and edema, too little dec preload
-avoid coughing/bucking w/ emergence
-keep ETT and mechanical ventilation early postop unless obstruction relieved

98
Q

mediastinoscopy, shortly after induction, scope advnaced when pt hypoTN ddx?

A

-surgical compression of brachiocephalic artery
-induction medication or inhaled anesthetics causing vasodilation
-PTX
-allergic reaction
-vagal reflex from manipulation of trachea, great vessels or vagus n
-autonomic neuropathy (LES)
-red preload w/ SVC syndrome
-MI or arrhythmia

99
Q

mediastinoscopy, shortly after induction, scope advnaced when pt hypoTN, what to do?

A

-check a line for accurary
-check BP on L arm (difference in arms = brachiocephalic compression)
-ask surgeon regarding hemorrhage, or compression of structures
-ensure adequate O2 and ventilation
-blook at EKG to r/o arrhythmia or ischemia
-ausculate breath sounds -> dec volatile, give fluids and pressors as indicated

100
Q

Main concern following mediastinoscopy

A

PTX!
req CXR priot to d/c

101
Q

Mediastinoscopy, major bleeding, now what?

A

-call for help
-ensure adequate IV access on feet -> run products through here
-ask surgeon to pack
-fluids and vasopressors
-have blood brought to room -> initiate MTP
-blood warmer, call for cell saver, rapid infuser
-switch to DLT if thoracoty needed
-precordial doppler -> inc risk of venous air embolism w/ vascular injury

102
Q

SOB VC not moving, midline position

A

b/l partial RLN injury
-reintubate -> mechanically venilate, suppl O2
-alert surgeon and ENT
-give pt sedation

103
Q

Complications w/ mediastinoscopy

A

-tracheal compression/laceration
-cerebrovacular events (a compression)
-R U limb ischemia
-compression of aorta -> reflex bradycardia
-PTX
-RLN or phrenic n inury
-venous air embolism
-medistainal hemorrhage
-esophageal tear

104
Q

post mediastinoscopy in ICU, rapid hypoTN, what to do?

A

-auscultate chest
-check ventilator settings
-ensure adequate oxygenation
-trendelenberg postion
-fluids, vasoconstrictors, inotrops
-ensure IV access, echo, surgeon, and possible central line placement

105
Q

Cushings dx symptoms

A

truncal obesity
admonial straiae
HTN
hyperglycemia

106
Q

function of pituitary gland

A

-anterior: syntehssis, storage and secretion of ACTH, TSH, LH, FSH, GH, prolactin
-posterior: stores and secretes ADH and oxytocin

107
Q

Bromocriptine MOA

A

dopamine agonist => decrease of GH and prolactin release

108
Q

Octreotide MOA

A

somatostatin analogue -> inh of GH from pituitary

109
Q

Acromegaly blood test

A

Insulin like Growth Factor-1 serum (less variable throughout the day) and oral glucose tolerance test (serum GH remains high despite glucose ingestion)

110
Q

Why difficult airway in acromegaly

A

distorted facial anatomy
macroglossia
epiglottic enlargement
overgrowth of mandiel
narrowed glottic opening
RLN paralysis

111
Q

radial arterial line in acromegaly?

A

no -> poor collateral flow to ahnd inc ischemia -> use dorsalis pedis or femoral

112
Q

pituitary surgery, sudden drop in BP ddx?

A

-hemorrhage
-VAE
-MI, arrhythmia
-anesethetic OD
-delayed allergic rxn

113
Q

Treatment for VAE

A

-immediately have surgeon flood the field
-place central line and attempt to aspirate
-provide support w/ fluids, vasoconstrictor, inotropes
-treat bronchospasm w/ albuterol
-LLDQ position if needed

114
Q

Plan for extubation in pituitary surgery if CSF space had been opened intraop

A

-still plan to maintain similar extubation criteria and wake the patient up if difficult airway
-can give lidocaine IV prior to extubate to dec risk of coughing to prevent reopening of CSF leak

115
Q

OSA obtunded in PACU, ddx?

A

-postop airway obstruction and apnea (esp w/ narcotics)
-atelectasis (intraop hypoventilation)
-pulm edema (CHF, VAE)
-aspiration
-inadequate reversal of NMB
-hypo/hyperglycemia
-electrolyte abnormalities
-arrhythmia, MI
-stroke

116
Q

post sphenoidal surgery, pt has OSA, how to manage postop

A

CANT USE CPAP -> risk for pneumocephalus
-maintain seated or lateral position -> supplemental O2 until able to maintain baseline on room air
-multimodal analgesia to minimize sedatives/narcotics
-continuous pulse ox -> monitor for several hours

117
Q

post pituitary surgery pt starts producing copious urine, ddx?

A

-central diabetes insipidus (not producing enough ADH)
-diuretic administration
-hyperglycemic diuresis

118
Q

How to diagnose diabetes insipidus

A

-dec urine specific gravity < 1.005
-hyperglycemia is ruled out
-responds to exogenous ADH

119
Q

Treatment for diabetes insipidus

A

-replace UOP w/ 1/2 NS w/ maintanence infusion
-larger volumes: vasopressin or desmopressin (DDAVP)

120
Q

post pituitary tumor removal, POD 4 pt hypotensive refractory to fluid boluses and vasopressors, ddx?

A

adrenal insuff 2/2 panhypopituitarism
-pituitary hemorrhage/ischemia

121
Q

periop concerns dissecting anuerysm

A

-aneurysm rupture
-propagation of aneurysm
-MI
-periop hemodynamic instability esp w/ cross clamping and possibility of potential massive blood loss
-postop respiratory complications
-paraplegia (disruption of radicular arteries supplying SC)
-stroke
-hemorrhage
-CHF

122
Q

DeBakey classification of aortic dissection

A

-type I: start in ascending aorta, extend to involve descending aorta
-type II: originate in ascending aorta, and do not extend beyond brachiocephalic
type III: originate beyond L subclavian and extend to diaphragm or aorto-iliac bifurcation

Type I & II: surgical III: medical management
III surgery if significant dilation, risk of rupture or end organ ischemia

123
Q

Stanford aortic dissection classification

A

type A: ascending aorta w/ or w/o involvement of arch or descneding aorta
type B: ascending aorta not involved

124
Q

Ideal time to start beta blockers prior to surgery

A

2-7 days

125
Q

aortic repair postop resp failure

A

high incidence 25-45%
-have CXR, H&P

126
Q

Dibucaine number

A

indirect measure of pseudocholinesterase activity -> when injected will inhibit butyl cholinesterase
-normal: 70-80
-hetero: 50-60
-homo recessive less than 50, will have a block for hours

127
Q

Fever w/ blood transfusion ddx

A

-febrile nonhemolytic transfusion reaction
-acute hemolytic transfusion reaction
-TRALI
-bacterial/viral contamination

128
Q

Differentiation of CSW and SIADH

A

SIADH: euvolemic, UNa < 100
CSW: hypovolemic, UNa > 100

129
Q

Treatment SIADH

A

water restriction, demeclocyline (diminishes responsiveness to ADH), diuresis

130
Q

Treatment cerebral salt wasting

A

IV fluids

131
Q

What % of PPV is considered to be fluid responsive?

A

> 12%
-if mechanically ventilated w/ TV of at least 8 cc/kg

132
Q

When can PPV not be reliable?

A

spontaenous ventilation
low TV
pulm HTN
dec lung compliance
open thoracic cavity
arrhythmias
inc abd pressure

133
Q

What is pulse pressure variation?

A

Difference between systolic and diastbolic BP and it varies w/ respiration during postitive pressure ventilation -> dyanmic marker used to determine if pt is a fluid responder
-idea of where pt is on Frank-Starling curve

134
Q

Pulse pressure variation equation

A

PPV = (PPmax -PPmin)/ PP mean x 100

135
Q
A

Anesthesia Oral Boards (8 decks)

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