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Anesthesia Oral Boards > UBP Condensed2 > Flashcards

UBP Condensed2 Flashcards

1
Q

Mg dosing for PEC

A

4-6g bolus over 20 minutes
Infusion of 1-2 grams per hour

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2
Q

Mg PEC therapeutic range

A

4-6

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3
Q

Mg toxicity

A

> 10: loss of DTR
15: resp depression
20: cardiac arrest

EKG: prolonged PR, widened QRS
Tx: calcium, diuretics

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4
Q

Anti-HTN in pregnancy

A

Labetalol 1st line
Hydralazine: reflex tachycardia
NG
Nitorprusside (risk of CN toxicity)
Nifedipine (cant’ use w/ Mg: risk of myocardial depression)

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5
Q

HELLP

A

Hemolysis, elevated liver enzymes, low plts
Tx: Mg, delivery of baby

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6
Q

Drugs that DON’T cross placenta

A

He is Going Nowhere Soon
heparin
Insulin
Glyco
Non-depolarizing NMB
Succ

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7
Q

Antepartum bleeding ddx

A

Placenta Previa v placenta abruption MC!! painless previa, painful abruption
Less common: vasa previa (fetal vessels overlie internal os), uterine rupture

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8
Q

Uterotonics

A

Oxytocin: in Ca and contractions -> causes hypoTN, nausea, water retention (similar to ADH)
hemabate: Prostaglandin, inc Ca -> bronchospasm
Methergine: alpha agonist on blood vessels and smooth muscle -> HTN
Misoprostol: prostaglandin -> tachycardia/fever

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9
Q

Number 1 determination of fetal well being

A

FHR variability!!!
Normal 6-25 bpm variability
NORMAL: 110-160

**can use fetal scalp capillary pH

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10
Q

Early decelerations

A

Fetal head compression

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11
Q

Late decelerations

A

Uteroplacental insufficiency

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12
Q

Variable decelerations

A

Umbilical cord compression

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13
Q

Molar pregnancy concerns

A

Abnormal bleeding
CHF
Pulm insufficiency
Hyperthyroidism/thyrotoxicosis
DIC
PE

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14
Q

acute resp distress in peripartum period

A

Tocolytic induced pulm edema
Steroids
PE/AFE
ARDS

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15
Q

Alternatives besides neuraxial for preg pain control

A

Paracervical block: 1st stage of labor T10-L1 -> assoc w/ fetal hypoxia, uterine artery constriction, inc uterine tone
Paravertebral lumbar symp block: 1st stage of labor
Pudenedal nerve block: 2nd stage of labor S2-4

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16
Q

APGAR

A

Appearance
Pulse 0: none 1: < 100, 2: >100
Grimace
Activity
REspirations

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17
Q

Treatment for meconium aspiration syndrome

A

If resp depression w/ HR < 100: consider suctioning ETT
-otherwise dry and stimulate -> give exogenous surfactant!! (Meconium inactivates surfactant)

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18
Q

Neonatal resuscitation NALS

A
  1. Stimulate, if apneic or HR < 100: clear airway and PPV 30 breaths/min
  2. After 30 seconds: if HR < 100: ventilation
  3. After 30 seconds: if HR < 60: intubate, FiO2 100%, start chest compressions at 100/min and IV/IO access
  4. If HR still < 60 after 30 seconds:give epi (0.01-0.03 mg/kg) and fluids
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19
Q

Epi dosing for neonate

A

0.01 mg/kg

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20
Q

Epi dosing for ETT

A

0.1 mg/kg

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21
Q

Normal umbilical artery gas

A

PH; 7.27, pCO2: 50, pO2: 22, bicarb 22

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22
Q

Normal umbilical vein gas

A

PH: 7.35, pCO2 38, pO2 29, bicarb 20

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23
Q

Best time to have surgery while pregnant

A

2nd trimester
-avoid miscarriage/organogenesis in 1st
-avoid preterm labor in 3rd

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24
Q

When to give ppx steroids

A

Between 24-34 weeks w/ anticipation of preterm labor

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25
Q

Ppx steroids or tocolytics in non OB Surg for pregnant patient?

A

Not indicated

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26
Q

Intraop considerations for pregnant pt for non OB surgery

A

Standard monitors
LUD
FHR! (Can monitor if > 18 weeks) and tocodynamometer! (Look for preterm contractions!)

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27
Q

Goals for laproscopic surgery w/ pregnant pt

A

Minimize insufflation pressures: 8-12
EtCO2 32!

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28
Q

Postop pregnant pt for non OB surgery

A

-monitor MINIMUM of 12 hours for preterm labor
-if preterm labor: beta agonists, Mg, betamethasone! If b/w 24-34 weeks

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29
Q

Thesis isosensitization

A

-Rh neg moms w/ Rh positive fathers get RhoGAM at 28 weeks and 72 hours after delivery -> antibody destroys Rh + cells before Rh - mom can form antibodies to them
-if no rhogam -> Rh neg moms make antibodies to Rh + blood from fetus -> IgG Ab will cross placenta and lead to hemolytic dx of newborn

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30
Q

Emergency c/s w/ difficult airway

A

FiO2 100%, LUD, treat hypoTN
-awake fiber optic if time
-if no time: RSI, difficult airway equipment and maintains sp vent w/ ketamine/inhalational

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31
Q

CT in pregnancy?

A

IF trauma, can do if unstable to access damage -> treating condition of mom is most effective way to maintain health of baby!

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32
Q

hypocalcemia EKG changes

A

prolonged QT interval on EKG

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33
Q

changes in lytes in ESRD

A

hypoNa, hyperK, hypoCa, metabolic acidosis

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34
Q

can you use HD catheter for ESRD case?

A

Yes, if last result: draw back heparin and use aseptic technique: inc risk of clots and infxn

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35
Q

RF for postop AKI

A

advanecd age
ASA
ACE inh (dec kidney response to dec RBF)
contrast
DM
HTN
CHF
hypoTN

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36
Q

assessing volume status in ESRD

A

last HD
weight to dry weight
CXR
pulm edema
peripheral edema
JVD
orthostasis

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37
Q

morphine in ESRD

A

6-MP metabolite is active and prolonged -> risk of resp depression

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38
Q

meperidine and ESRD

A

normeperidine metabolite excreted renally -> builds up and can cause seizures

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39
Q

K cutoff for kidney transplant

A

if > 5.5 delay for dialysis

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40
Q

if need to give blood in a kidney transplant, what kind of blood do you give?

A

washed (leukocyte reduced), irradiated (red GvH), CMV negative blood

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41
Q

spinal level goal for TRUP

A

T9-10
bladder sensation: T11-12
perineum S2-4

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42
Q

HypoTN in TURP ddx

A

bladder perforation (nause,a diaphoresis, bradyacardia, abd/shoulder pain)
bleeding
transient septicemia (bacteria from prostate into open venous sinuses)

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43
Q

myasthenia gravis pathophys

A

antibodies to post junctional nicotinic ACh receptors

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44
Q

inhaled anesthestics in MG

A

potentiate wekaness -> should place a n monitor even w/ no muscle relaxants

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45
Q

postop predictors of mechanical ventilation in MG

A

pyridostigmine dose > 750 mg daily
dx > 6 years
VC < 2.9 L
other pulm dx (COPD)
bulbar symptoms
EBL > 1L

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46
Q

AHI index

A

the combined average number of apneas and hypopneas that occur per hour of sleep

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47
Q

Treatment of thyrotoxicosis

A

-propanolol: dec conversion of T4-> T3
-methimazole, PTU (PTU works fast w/ glucocorticoids to dec conversion)
-iodine prevents release of thyroid hormones but use last!
-acetaminophen for fevers (NO ASA -> inc free T3, T4)

if everything else fails can do plasmapheresis

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48
Q

Thyrotoxicosis

A

a fib, inc CO2, inc O2 consumption, dec SVR, dec PVR
inv Minute ventilation
anxiety, tremors
sweating
**thyroid storm: metabolic, thermoregulatory, CV mechanisms fail -> just treat

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49
Q

treatment for thyrotoxicosis

A

propranolol (prevents conversion)
other beta blocks for symptoms
methimazole, PTU
PTU + glucocorticoids: work faster
iodine (prevents release)
acetaminophen for fevers

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50
Q

Hypothyroidism

A

low cardiac output: dec contractility, dec SV, bradycarida
pleural and pericardial effusions
hypothermia
macroglossia
SIADH

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51
Q

Myxedema coma

A

loss of DTRs, hypothermia, hypoventilation, hypoNa, coma

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52
Q

teratment for myxedema coma

A

ICU admission
correct lytes and hypovolemia
give T3 and T4
give hydrocortisone
heat pt
mechanical ventilation

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53
Q

hypothyroidism intraop complications

A

difficult intubation (large tongue)
hypoglycemia
anemia
hypoNa
hypothermia
hypoventilation (dec CO2 production)
hypoTN
delayed awakening

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54
Q

agents to avoid in pheo

A

histamines (atracurium, morphine)
droperidol
metoclopramide
pancuronium
ketamine/ephedrine/atropine
succ (fasciculations inc catecholamine release)
pain, anger, anxiety
hypoxia, hypoTN, hypercarbia

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55
Q

Diabetes insipidus treatment

A

DDAVP
vasopression
fluids: maintenance and 2/3 UOP

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56
Q
A
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57
Q

Thyrotoxicosis agents to avoid

A

Pancuronium
Ketamine
Glyco
Atropine
Des
Ephedrine
Epi
**anything that stimulates symp system

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58
Q

Loss of DTR, hypothermia, hypoventilation, hypoNa, somnolent

A

Hypothyroidism: myxedema coma

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59
Q

Diagnosis for pheo

A

Most sensitive: plasma metanephrines
Plasma catecholamines
Urine metanephrines
Urine Vanillylmandelic acid

60
Q

Meds to avoid in pheo

A

histamine (atracurium, morphine)
Droperidol
Metochlopramide
Pancuronium
Ketamine/ephedrine/atropine
Succ (fasciculations inc catecholamines release)
Glucagon
Halo one
Pain, light anesthesia
Hypoxia/hypoTN/hypercarbia

61
Q

HTN w/ pheo intraop

A

Treat w/ short acting agents: esmolol, nicardipine, clevidipine, Mg

**be careful w/ NG -> can get tachycardia
**nicardipine: selective arterial vasodilator

62
Q

When to give steroids w/ pheo

A

If b/l adrenalectomies

63
Q

Postop after pheo

A

Hypoglycemia (inc insulin, catecholamines inhibit insulin)
HTN: if sustained retained tumor, if present but lower, can be catecholamines from peripheral n being released
Somnolence

64
Q

Anesthesia concerns w/ acromegaly

A

Difficult airway: macroglossia, large jaw, thickened pharyngeal nad laryngeal soft tissues
OSA
HTN
Glucose intol/insulin resistance
Ulnar/radial muscle myopathy: no a line in wrists, use DP

65
Q

Dx of acromegaly

A

IGF-1, GH

66
Q

treatment of acromegaly

A

Bromocriptine and octreotide

67
Q

Cushing syndrome symp

A

(Excessive ACTH)
Moon fancies
HTN
Hyperglycemia
OSA/GERD
HyperNa, hypoK (inc sensitivity to m relaxants)

68
Q

Diabetes Insipidus

A

HyperNa
Dilute urine

69
Q

tx for diabetes Insipidus

A

DDAVP, vasopressin, fluid replacement (maintenance and 2/3 UOP)

70
Q

Diarrhea, flushing, heart murmur

A

Carcinoid triad (pulm stenosis or TR)

71
Q

Carcinoid tumor

A

Releases histamine, bradykinin, and serotonin
-if in GI -> cleared by liver, no carcinoid syndrome

72
Q

Carcinoid syndrome

A

Mets to liver/pulm/breast
-flushing, diarrhea, hypoTN, HTN
R heart dx
Bronchoconstriction (bradykinin)

73
Q

Dx of Carcinoid syndrome

A

24 hour urine 5_hydroxyindoacetic acid

74
Q

Preop for carcinoid syndrome

A

Echo (can get R heart serotonin fibrosis -> TR)
IVF
Octreotide (Dec release of serotonin)
H1 and H2 blockers
Alpha/beta blockers

75
Q

Carcinoid syndrome intraop

A

Avoid succ: fasciculations and histamine release -> HTN
-bronchospasm 2/2 manipulation of tumor -> ask surgeon to stop, give octreotide and Benadryl
reserve epi unless needed, can worsen carcinoid

76
Q

DM and difficult airway

A

Stiff joint syndrome
-glycosylation of proteins/collagen cross linking

77
Q

DKA diagnosis

A

anion gap metabolic acidosis
Urinary ketones

78
Q

Tx DKA

A

IVF w/ K replacement
Insulin to lower glucose (75-100 per hour to avoid cerebral edema)
When glucose < 250 add dextrose
-monitor lytes until gap closed

79
Q

Diagnosis of hyperosmolar hyperglycemic state

A

Glucose >600
Serum osm > 320
*no ketones

80
Q

HHS hyperosmolar hyperglycemic state tx

A

IVF
Insulin
LMWH to prevent clots
Abx if in fxn

81
Q

Chronic steroid implications

A

Impairs wound healing
Inc skin friability
Inc risk of fxn, in fxn, GI bleed, ulcers

82
Q

When to get stress dose steroids

A

20mg prednisone for more than 3 weeks w/i the year
-clinical Cushing’s syndrome

83
Q

Rheumatoid arthritis considerations

A

-pericarditis, valvular fibrosis, arrythmias (rheumatoid nodules in conduction system)
-pulm fibrosis, pleural effusions

84
Q

Glaucoma

A

Pathological elevation of increased intraocular pressure due to outflow obstruction of aqueous humor from eye

85
Q

Succ and globe injury

A

Can give if give defasiculating dose -> acknowledge succ can inc IOP

86
Q

Ketamine and eyes

A

Inc IOP

87
Q

Etomidate and IOP

A

Inc due to myoclonuss

88
Q

Retrobulbar block

A

Injecting local anesthesia inside muscle cone
-close to optic n and opthalmic artery
-less volume
RISKS: retrobulbar hemorrhage, central retinal artery occlusion, perforation of globe, spread into CNS, OCR, optic n atrophy

89
Q

Peribulbar block

A

-local anesthesia injected above and below orbit into orbicularis oculi muscle
-less risk of intraocular or intramural injxn
-less risk of direct injury
-harder to get dense block
-compl: periorbical ecchymoses, transient blindness, contra lateral eye

90
Q

Nitrous oxide and air

A

Concern of gas injection in eye -> different gases have different timelines -> longest 30d, don’t use nitrous w/i 30 days of eye surgery

91
Q

Disorders linked to MH

A

Central core dx
King Denborough Syndrome
-defect of ryanodine receptor -> in in Ca and muscle contraction

92
Q

If masseter muscle rigidity, give dantrolene?

A

Yes due to MMR and high assoc w/ MH

93
Q

What is EMLA cream?

A

Prilocaine/lidocaine: risk of Met-Hg

94
Q

Jehovah’s Witness minor

A

-minor: if life threatening can give blood without appealing to court
-if parents don’t want you to give blood products -> identify which are acceptable and tell them attempt to avoid BP but if life threatining would seek approval from court to administer blood

95
Q

Positive pregnancy test in minor

A

-check state emancipation laws
-tell pt, encourage to tell parents, arrange f/u

96
Q

Risks of IO

A

Osteomyelitis, fat embolism, marrow embolism, compartment syndrome

97
Q

At what age risk of apnea and bradycardia of prematurity w/ anesthesia

A

< 60 weeks post conceptual

98
Q

Glucosuria in infants

A

< 34 weeks: normal, immature renal reabsorption
> 34 weeks: hyperglycemia

99
Q

Prematurity time frame and risks

A

< 37 weeks
RDS, hypoglycemia, apnea, retinopathy of prematurity, intraventricular hemorrhage, NEC, pulm HTN of newborn

100
Q

ETT sizes newborn

A

3 < 3500g
2.5 if < 1500g

101
Q

Newborn Hct transfusion goals

A

> 35%
Prematurity has more fetal Hg -> leftward shift of Hg O2 dissociation curve

102
Q

How dose PDA normally close

A

Normal 2-4 days after birth
-Inc arterial O2 and dev PVR -> Dec PG -> closure
-if premature, have RDS/hypoxia and Dec contractility of muscular layer of PDA

103
Q

Treatment for PDA

A

-indomethacin: SE thrombocytopenia, mesenteric perf, renal injury, hypoNa
-ibuprofen used in low birth weight infants

104
Q

monitors for PDA ligation

A

2 pulse ox: R hand lower extremity (pre and post ductal)
-if LE O2 sat is lower -> means R to L shunting

GOAL: PaO2 50-80, SpO2 87-94%
-transfuse Hct > 40 if premature or > 25 full term

105
Q

Resp Distress Syndrome v Bronchopulm Dysplasia, which one is first?

A

RDS -> BPD

106
Q

Why do infants get respiratory distress syndrome?

A

Lack of surfactant

107
Q

Timeframe for retinopathy of prematurity

A

< 44 weeks post gestation age
RF: low birth weight, prematurity, hyperoxia, hypoTN

108
Q

Full term normal vitals

A

HR 125-135, BP 50-70/35-50, 40 breaths

109
Q

No shivering thermogenesis

A

Hypothermia -> NE release -> metabolism of brown fat

110
Q

Symptoms of TEF

A

Intrauterine polyhydramnios (can’t swallow amniotic fluid)
OGT coiling
Drooling cough cyanosis w/ feeding

111
Q

TEF induction/intubation

A

2 IVs, a line L arm (R thoracotomy)
Avoid PPV, ketamine/inh for spontaneous ventilation until fistula ligated
-use fiber optic to look for tracheomalacia

112
Q

Complications TEF

A

Anastomotic leak
Esophageal dysmotility
Reflux
Tracheomalacia
VC paresis
Post-intubation croup

113
Q

Tetralogy of Fallot

A

POVR: Point of View Right?
Pulmonary atresia
Overriding Aorta
VSD
RVH

114
Q

How to manage cyanotic spells (R to L shunt) under anesthesia

A

Deepen anesthetic
100% FiO2
Vasopressors or ketamine to inc SVR (switch shunt)

115
Q

Congenital diaphragmatic hernia

A

Nasal flaring, sternal retractions, absent L breath sounds
-> assoc w/ aortic coarctation

116
Q

Pulm HTN tx

A

Avoid hypoxia, hypercarbia, acidosis, hypothermia
USE inhaled nitric oxide

117
Q

Down Syndrome associations

A

-CV: congenital heart defects (endocardial cushion defects, ASD, VSD)
-airway: macroglossia, Atlanta-axial instability, subglottic stenosis
-GI: duodenal atresia, delayed gastric emptying (RSI)

**need echo and cervical spine XR prior
-difficult airway equipment, ENT surgery on standby, fiber optic

118
Q

Propofol infusion syndrome

A

-peds and ICU!
-prolonged dose -> bradycardia, metabolic acidosis, rhabdo, hyperK, liver failure, renal failure, cardiac failure

119
Q

Nitrous oxide in omphalocele

A

No, can distention bowel and impaired reduction

120
Q

Beckwith-Wiedemann Syndrome

A

Macrosomia
Macroglossia
Hypoglycemia
Polycythemia

121
Q

Trauma Hs&Ts

A

Hypoxia
H+ acidosis
Hyper or Hypokalemia
Hyper or Hypoglycemia
Hypothermia

Toxins
Thrombosis (MI or PE)
Tamponade
Tension PTX
Trauma

122
Q

Pyloric stenosis how to tell when rehydarated prior to surgery?

A

Cl 100
PH 7.3-7.5
Bicarb < 30
UOP 1-2 cc/kg/hr

**prior is a hypochloremic hypoK hypoNa metabolic alkalosis

123
Q

Succ dose in neonates

A

2-3 mg/kg due to higher volume of distribution

124
Q

Hemolysis what labs to send after blood transfusion?

A

Haptoglobin (decreased)
Bilirubin: unconjugated/ indirect elevated
Repeated cross matching
Direct antiglobulin test
Urine free hemoglobin

125
Q

Hemophilia A

A

Factor VIII def
-if don’t respond to factor VIII, give factor VIIa (activates thrombin directly)
-prolonged PTT
-give factor 8 concentrate, DDAVP (released factor VIII and vWF from endothelium suitable fo minor hemophiliacs)

126
Q

Meds to avoid in hemophilia A

A

NSAIDs
ASA
Antihistamines
Antitussives (inhibit plt aggregation)

127
Q

Hemophilia B

A

Def factor IX
-normal PT, prolonged PTT
-less common than A -> can only tell apart by activity levels

128
Q

Von Willebrands Dx

A

Prolonged bleeding time, normal plts, bleeding diasthesis
-vWF allows plts to be adhered to damaged endothelium and carries factor VIII
-give DDAVP -> helps endothelium release

129
Q

Hypocalcemia

A

Prolonged QT
Hypotension
Myocardial depression

130
Q

FFP need to match AB +/-

A

Needs to match A B (plasma will have antibodies)
But the +/- doesn’t matter -> b/c RBCs have the Rh antigen

131
Q

What’s in cryo?

A

Fibrinogen
Factor VIII
VWF
Factor XIII
Fibronectin
***give if volume concerned or specific factor def [hemophilia A, vWD, low fibrinogen]

132
Q

Universal pRBC donor

A

O neg

133
Q

Universal pRBC acceptor

A

AB

134
Q

Universal FFP donor

A

AB

135
Q

Universal FFP acceptor

A

O neg

136
Q

Massive blood transfusion: citrate?

A

Calcium chelation -> becomes hypoCa
When metabolized by liver -> bicarb -> alkalosis and hypoK

137
Q

With citrate-related hypoCa, how to treat?

A

Check for hypoMg!! CALCIUM WON”T WORK UNLESS MG REPLETED -> give Mg and Ca chloride or gluconate

138
Q

Absolute contraindications of cell saver

A

Bacterial contamination of field, cancer
Relative: SCD, pheo, contamination w/ urine, bowel contents, amniotic fluid

139
Q

Lupus anticoagulant

A

Normal PT
Prolonged PTT
**Prothrombotic

140
Q

Heparin MOA

A

Inc activity of ATIII -> inhibit thrombin

141
Q

Enoxaparin MOA

A

Binds to AT3 which inhibits factor X -> Factor Xa (prevents conversion of prothrombin to thrombin)

142
Q

Argatroban

A

Direct thrombin inhibitor
Can be used instead of heparin in pts w/ HIT
Can monitor w/ PTT or ACT

143
Q

Acute Intermittent Porphyria

A

When enzyme in heme biosynthesis pathway is deficient

144
Q

Acute Intermittent Porphyria symptoms

A

N/v, abd pain, autonomic instability, sz, resp failure, skeletal muscle weakness

145
Q

Acute Intermittent Porphyria meds to AVOID

A

Etomidate
Keorolac
Methohexital
Nifedipine

146
Q

Acute Intermittent Porphyria safe drugs

A

Safe:
Propofol
Ketamine
Nitric Oxide
Volatiles
NMB
Benzos
Opioids
Regional is safe

147
Q

Acute Intermittent Porphyria Crisis treatment

A

Glucose containing IVF (carbs suppress porphyria)
Hemodynamic support
Haematin

Anesthesia Oral Boards (8 decks)

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