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Areviewbook > Yao Book > Flashcards

Yao Book Flashcards

1
Q

Dyspnea wheezing coughing periodic attacks think

A

Asthma

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2
Q

Asthma is seen more in males in

A

2:1 ratio

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3
Q

Bronchospasm is usually

A

Cholinergic mediated

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4
Q

Airway hyperactivity, chronic inflammation, expiratory airflow obstruction

A

Asthma

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5
Q

Inhaled allergens are common triggers of

A

Asthma

Activate mast cells with bound IgE, directly leading to the immediate release of a bronchoconstrictor

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6
Q

Hypoxemia is a universal finding in

A

Asthmatic attacks

Don’t see C02 retention as much. More hyperventilation

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7
Q

Preop eval asthma

A

Frequency, hospital visits, use of systemic steroid, prior mechanical ventilation for severe attack

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8
Q

Airway resistance is high in

A

Obstructive disease

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9
Q

ERV

A

Max volume of gas that can be exhaled after normal expiration

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10
Q

Residual volume

A

What stays in lungs after forced expiration

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11
Q

VC normal

A

60 yo 70 ml/kg

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12
Q

TLC

A

VC + RV

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13
Q

Obstructive lung disease

A

Long expiration phase

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14
Q

CC

A

Lung volume at which small airways in dependent parts of lung begin to close

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15
Q

COPD

A

CO2 retention

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16
Q

2 to 3 weeks after clinical recovery in children from URI to do

A

Anesthesia

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17
Q

30mg of hydrocortisone is released

A

Each day from body

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18
Q

Histamine mediates bronchoconstriction through

A

H1

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19
Q

Asthmatic induction want to

A

Block airway reflexes before laryngoscopy and intubation

Relax airway smooth muscle
Prevent release biochemical mediators

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20
Q

Propofol best for

A

Asthmatic induction

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21
Q

Light anesthesia in an asthmatic will lead to

A

Bronchospasm

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22
Q

D tubocuranine

A

Can cause bronchospasm through histamine release

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23
Q

Manage severe wheezing attack

A

Deepen level of anesthesia and increase Fi02

Then relieve mechanical stimulation
Suction endotracheal tube

Can give albuterol

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24
Q

Most common cause of asthmatic attack during surgery is

A

Light anesthesia

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25
Q

Non small cell you can treat

A

Surgically but small cell is medical

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26
Q

TNM

A

T is for tumor size
N if lymph node involvement
M distal metastasis beyond ipsilateral hemothorax

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27
Q

Pancoast syndrome

A

Pain and upper extremity weakness due to invasion of the brachial plexus

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28
Q

COPD

A

Chronic bronchitis and emphysema

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29
Q

Aerobic capacity gold standard is

A

VO2 Max

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30
Q

Cervical mediastinoscopy

A

To establish diagnosis don’t use on patients with cancer spread lymph nodes

Can cause pneumo or perforation of bleeding structures so might need to pack SVC so need access in lower extremities

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31
Q

Right VATS

A

Put a line on left radial

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32
Q

Most double lumen tubes are made with

A

Polyvinyl chloride

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33
Q

DLT five sizes

A

28, 35, 37, 39 and 41 French

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34
Q

When bronchial cuff is deflated on double lumen tube you should hear an

A

Air leak

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35
Q

Absolute for double lumen tube

A

VATS for surgical exposure
Bronchopleural fistula
Isolation of contamination- bronchiectasis lung abscess or massive hemorrhage

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36
Q

No DLT if

A

Difficult anatomy
Lesions that could be traumatized when moving tube in
Small patient where 35 is too big and 28 is too small

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37
Q

Left mainstem bronchus is much longer than the

A

Right

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38
Q

Advantage of bronchial blocker

A

If too small to fit DLT
Difficult airway
If DLT contraindicated

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39
Q

Disadvantage of bronchial blocker

A

Can’t suction well
Possible stapling of stump if not retracted appropriately
Need to use fiberoptic to position

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40
Q

Depxyhemoglobin 660

A

Oxyhemoglobin 940mm

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41
Q

Right lung gets

A

55% of blood flow

Left lung gets 45%

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42
Q

Inhalation agents inhibit

A

HPV

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43
Q

Once atelectactic all the blood flowing into the

A

Nonventilated lung is shunt flow

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44
Q

Improve oxygenation in single lung ventilation

A 
Use 100% oxygen 
Check position of tube with fiberoptic 
Ventilate manually you see tidal volume that is good
Add peep if larger tidal volumes helped
Use two lung ventilation intermittently

Can decrease the shunt
Use drugs to augment HPV(phenylephrine, norepinephrine)
Clamp liver vessels or the pulmonary artery of the nonventilated lung temporarily

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45
Q

DLT tubes have large outer diameter which can cause airway edema and

A

Trauma if left in too long

Can convert to single lumen tube if need post op ventilation

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46
Q

Intrathecal opioids can act for

A

18 to 24 hours

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47
Q

Intrathecal morphine can cause

A

Late respiratory depression

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48
Q

Lipophilic narcotics

A

Fentanyl methadone meperidine

Act quick

Can last 6 to 7 hours

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49
Q

Morphine is hydrophilic and has slow onset of action(15 to 30 minutes)

A

Max pain relief at 1 hr

Lasts for more than 12 hours

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50
Q

.2 ucg/kg/hr

A

Ketamine or precedex infusion

Precedex can lead to hypotension and bradycardia

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51
Q

Intercostal/Paravertebral nerve block for

A

Thoracoscopy or thoracotomy pain control

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52
Q

80% of patients who have undergone lung resection complain of

A

Ipsilateral shoulder pain unresponsive to epidural block or systemic opioid

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53
Q

Aspiration

A

Big cause of mortality in elderly/those who have overdosed

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54
Q

Chemical aspiration pneumonitis

A

Respiratory distress, bronchospasm, cyanosis, tachycardia, dyspnea. CXR shows irregular mottled densities

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55
Q

Critical pH of aspirate causing problems

A

PH<2.5

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56
Q

Aspiration pneumonia

A

Infiltrate in a patient who is at risk for oropharyngeal aspiration

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57
Q

Initial management post aspiration

A

Rapidly tilt operating room table to 30 degree head down position
Have assistant hold cricoid while you suction mouth and pharaynx
Do intubation
OG tube to empty stomach

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58
Q

No abx for

A

Aspiration pneumonitis

Also corticosteroids are not recommended

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59
Q

Metochlopramide increases

A

LES tone and can be protective against aspiration pneumonitis

PPI before and OG give and giving antaacid solution can help

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60
Q

ARDS more severe than ALI

A

ARDS pa02/Fi02<200

ALI<300

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61
Q

Compliance is worse at

A

Extremes of lung volumes

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62
Q

Respiratory failure

A

Hypoxemia, hypercarbic, dyspnea

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63
Q

BIPAP for

A

Mild to moderate respiratory failure

Risk of aspiration

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64
Q

Intermittent PPV

A

Associated with decrease in cardiac output and in arterial blood pressure

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65
Q

Mechanical ventilation

A 
Decrease CO
Infection
ALI
Oxygen toxicity if inspired oxygen more than 60%
Endobronchial intubation, cuff leak
Fractured turbinates/epistaxis it nasal
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66
Q

Oxygen delivery formula

A

CO x 1.34 x hgb x Sa02 + 0.031 x Pa02

First fix cardiac output, next hgb, finally improve lung mechanics

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67
Q

Intrapulmonary shunting due to aspiration treat with

A

Avoid excessive tidal volumes
Increase PEEP
Make sure patient isn’t fighting the ventilator

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68
Q

5 to 10cm peep usually good and I’d not associated

A

With hemodynamic disturbances

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69
Q

PEEP improves arterial oxygenation with increase in

A

FRC

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70
Q

PEEP decreases venous return through increase in intrathoracic pressure

A

Leads to decrease in cardiac output

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71
Q

PSV is based on

A

Pressure and time

Flow cycled

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72
Q

PSV

A

Achieve larger tidal volume with lower airway pressures
Decreased work of breathing
Promote weaning from ventilator bc of decreased respiratory muscle weakness

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73
Q

ECMO used for patients in

A

Severe acute respiratory failure with potentially reversible lung disease, who are dying despite max vent care

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74
Q

Indications for ECMO by NIH

A

Pa02 less than 50 with 100% Fi02 and peep

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75
Q

Only absolute contraindication to not doing artificial lung(aka ECMO)

A

Active bleeding

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76
Q

HFJV

A

Small tidal volume at high flow rate

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77
Q

Don’t use HFV if can’t do passive expiration can lead to bad

A

Barotrauma

Also need adequate humidification
HFV need adequate training

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78
Q

Nitric oxide works in endothelium and goes to

A

Vascular smooth muscle where it activates cGMP

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79
Q

Inhaled NO may decrease pulmonary hypertension in ARDS due to

A

Hypoxic pulmonary vasoconstriction

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80
Q

Selection criteria for lung transplant

A

Severe ESLD with life expectancy<2 years
Minimal disease of other organ systems
Can follow strict regimen for rehabilitation and immunosuppressive therapy

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81
Q

Only absolute contraindication yo single lung transplant

A

Infectious lung disease(cystic fibrosis/bronchiectasis)

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82
Q

Premedication for lung transplant

A

Midazolam or midazolam plus diphenhydramine to protect lung against drug induced histamine release

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83
Q

For lung transplant need

A

Central venous access for pulmonary artery Catheter placement

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84
Q

Lung transplant it is hard to do preoxygenation so need to do it for a

A

Longer period of time
Rapid induction agent better to shorten excitement stage
Gradual induction bc don’t want abrupt withdrawal of sympathetic tone

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85
Q

Inhibition of HPV by

A

Volatile anesthetics

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86
Q

Isolated ventilation of dependent lung can lead to

A

Increase in peak inspiratory pressure and gradual progressive rise in pulmonary artery pressure

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87
Q

Clamping of pulmonary artery moves all cardiac output to

A

One lung

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88
Q

During process of vascular and bronchial anastomosis can get

A

Hypotension and regional wall motion abnormalities

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89
Q

Pulmonary artery pressure drops post

A

Reperfusion of new lung

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90
Q

CBP during lung transplant for

A

Right ventricular dysfunction not responding to medical therapy
Graft dysfunction
Surgical mistakes

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91
Q

Factors leading to more blood products being given

A

CBP
Double lung
Patients with cystic fibrosis

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92
Q

Complications of lung transplant

A

Early graft dysfunction
Infection
Rejection
Can have gross pulmonary edema

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93
Q

Triple vessel CAD

A

Progressive atherosclerosis of major branches of coronary arteries

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94
Q

Coronary arteries main ones

A

RCA
LAD branch of left main
Left Circumflex branch of left main coronary artery

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95
Q

Primary weakness of PCI is

A

Restenosis- mainly in first 6 mo

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96
Q

Reason for CABG

A

Significant left main disease
Multi vessel disease with left ventricular dysfunction
Three vessel disease that includes proximal LAD coronary artery

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97
Q

Evaluate Lft ventricular function

A 
Medical hx
Symptoms
Cardiac cath/ECho
EF
PAOP
Cardiac Index
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98
Q

Myocardial oxygen supply

A

Coronary blood flow x arterial oxygen content

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99
Q

Myocardial oxygen supply

A

Coronary blood flow x arterial oxygen content

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100
Q

Arterial oxygen content equation

A

1.34 x hgb x 02 saturation

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101
Q

Digitalis intoxication fueled by

A

Hypopotasium and hypercalcemia

Stop dig 1-2 days before cardiac bypass surgery

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102
Q

During CABG need to continue beta blocker even

A

Periop

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103
Q

Metoprolol half life

A

3 hours

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104
Q

Nifedipine

A

Calcium channel blocker

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105
Q

Verapamil is very

A

Antiarrhythmic

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106
Q

CVP line only if good left ventricular function during

A

CABG

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107
Q

Absolute contraindication to TEE

A

Esophagectomy
Active upper GI bleed
Oropharyngeal pathology
Esophageal pathology

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108
Q

Allen test looks for

A

Adequate collateral ulnar circulation

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109
Q

Core temp

A

Esophageal bladder nasopharyngeal tympanic sites

Not rectal

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110
Q

Diastolic pressure is higher in

A

PA than in RV

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111
Q

PAOP normal is

A

4 to 12 mm Hg
Heart failure is over 18
RV has large waves, PA smaller then PAOP

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112
Q

PA pressure for

A

High vs low pressure pulmonary edema
Primary pulmonary hypertension diagnosis
Monitoring and management of complicated acute mi
Management of hemodynamic stability after cardiac surgery

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113
Q

PA catheterization leads to

A

Infection
Hematoma
Air embolus
Thrombosis

Subclavian approach leads to
Pneumothorax
Hemo
Hydrothorax

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114
Q

Earliest and most sensitive sign of MI is

A

Regional wall motion abnormality

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115
Q

TEE can diagnose

A

Thoracic aortic aneurysm

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116
Q

CABG need

A

Smooth induction
Midazolam can be given to help prevent excitation leading to MI
Fentanyl 5 to 10 ucg/kg
Propofol 2 to 3 mg/kg

Don’t give benzos it over 70

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117
Q

Isoflurane

A

Most potent coronary vadodilator

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118
Q

Pancuronium causes

A

Tachycardia and HTN

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119
Q

In first time sternotomy

A

Ventilation must be held to protect the lungs from injury from the electric saw

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120
Q

Don’t keep swan ganz inflated continuously

A

Pulmonary infarction distal to the occlusion May ensue

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121
Q

Hgb higher than 11 per dL to donate

A

Blood for autologous transfusion

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122
Q

Intraop normovolemic hemodilution

A

Removal of blood post induction before CBP or administration of heparin

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123
Q

Salvaged blood is deficient in

A

Coagulation factors and platelets

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124
Q

Heparin at what dose for bypass

A

300 units per kg

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125
Q

AT3 forms

A

Irreversible complexes with thrombin

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126
Q

Heparin broken down by

A

Reticuloendothelial system

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127
Q

Heparin half life

A

100 minutes

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128
Q

MAP=

A

CO x TPR

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129
Q

Hypotension at beginning of bypass due to

A

Inadequate pump flow at beginning

Decreased plasma levels of catecholamines by hemodilution

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130
Q

Nicardipine

A

Systemic and coronary arterial dilator. Afterload is decreased, while preload not affected

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131
Q

Hypothermia decreases

A

Oxygen consumption

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132
Q

Hemodilution reduces

A

Hemoglobin concentration and hence decreases oxygen content

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133
Q

Blood viscosity varies

A

Inversely with temperature

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134
Q

Hypothermia prolongs

A

Onset of paralysis

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135
Q

Best way to monitor relaxation

A

Peripheral nerve stimulator

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136
Q

Oxygenater has flow can be decreased if

A

Pa02 is high and Pac02 is low

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137
Q

If hematocrit is below 18% during hemodilution

A

Blood is added to CBP circuit

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138
Q

Decrease myocardial o2 demand with

A

Cardioplegia and hypothermia

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139
Q

LV fraction below 25% can add

A

Milrinone or IABP or both

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140
Q

Protamine itself is an

A

Anticoagulant

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141
Q

IABP should be inflated immediately following

A

Closure of aortic valve at dicrotic notch of arterial tracing

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142
Q

Complications of IABP

A 
Ischemia of leg
Aortic dissection
Thrombus formation
Renal artery occlusion
Thrombocytopenia 
Infection
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143
Q

Stable blood gas to wean from bypass

A

PH 7.35 to 7.45
Pa02 80mm hg
Fi02 40
Pac02 35 to 45

Vital capacity> 10 to 15 ml per kg
Hemostasis<100 ml of chest tube drainage

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144
Q

Eccentric

A

Away from the center

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145
Q

Chronic AI shifts loop to the

A

Right

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146
Q

MR hallmark

A

Elevation in left atrial pressure

Giant CV wave and elevated pulmonary artery pressures

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147
Q

Mitral regurg you want afterload

A

Reduction

May have normal EF even though things are messed up

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148
Q

Can’t come off bypass post aortic mitral replacement think

A

Adequacy of myocardial preservation

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149
Q

High CVP and high pulmonary pressures

A

Pulmonary HTN

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150
Q

Nitric oxide is a

A

Potent inhaled pulmonary vasodilator

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151
Q

IABP is a

A

Catheter with large balloon at the tip

In thoracic aorta distal to left subclavian

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152
Q

TEE can show takeoff of left subclavian artery for

A

ISBP placement

Before placement can look at aorta for severe atheromatous disease or dissection which are contraindications of placement

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153
Q

Inflation of IABP just after

A

Dicrotic notch

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154
Q

Contraindication to IABP

A

AI, severe aortic disease

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155
Q

VAD used in management of chronic hearty failure after

A

Exhausting medical therapy

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156
Q

Minimally invasive cardiac surgery

A

Any procedure not performed with a full sternotomy and CB support

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157
Q

Main reasons for pacemaker

A

Sick sinus and complete heart block

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158
Q

Pacemaker for

A

Class 3/4 heart failure with dilated cardiomyopathy eF less than 35%, qRS>120 and sinus rhythm

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159
Q

Sick sinus syndrome

A

Array of disorders resulting from irreversible sinus node dysfunction

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160
Q

First degree block PR interval >

A

0.2 seconds

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161
Q

Mobitz type 1 PR increases until it drops

A

Mobitz type 2 no increase but QRS just drops

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162
Q

Paced Sensed Mode of Response

A

First 3 for pacemakers

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163
Q

For example VOO

A

Paces in the ventricle but does not sense intrinsic activity nor does it inhibits pacing and paces regardless of the hearts electric activity

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164
Q

Asynchronous mode paces at

A

Preset no matter what

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165
Q

Single chamber demand pacing paces at a preset rate only when

A

Spontaneous HR below programmed preset rate

For example if VVI 70 device would only pace in ventricle only if native HR less than 70

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166
Q

Is in synchronous mode hyperventilation can cause HR intrinsically to go

A

Up with the pacemaker

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167
Q

Dual chamber pacemakers can be used for

A

Sick sinus and all degrees of heart block

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168
Q

Current ICDs measure

A

R-R interval

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169
Q

ICD indications

A

Survivors of V fib V tach not from reversible cause
Ischemic cardiomyopathy EF<30% without recent MI in last 3 mo
Ischemia cardiomyopathy EF <35% with HF symptoms
Long and short QT
Hocm

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170
Q

All CIEDs should be interrogated at

A

3 to 6 mo before surgery

Establish type
Dependency on pacing
CIED function and programming details

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171
Q

PPM or ICD interrogation u want to know

A 
Battery life
Programmed pacing mode 
Pacemaker dependency 
Intrinsic rhythm
Behavior of magnet
Pacemaker lead parameters
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172
Q

For ICd or pacemaker need to determine

A

WMI during procedure
Grounding pad on
Do we need asynchronous mode
Temporary pacing and defibrillation be available

Only disables tachycardia detection and therapy of the ICD

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173
Q

A magnet cannot concert pacemaker in ICD system to

A

Asynchronous mode pacing

Only disables tachycardia detection and therapy of the ICD

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174
Q

Advisable not to use which gas after pacemaker placement

A

Nitrous

Air can go in pocket of pacemaker

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175
Q

For a patient with an ICD and magnet disabled strips who gets V tach mid surgery

A

Ask surgeon to stop all sources of EMI
Remove magnet to restart antitavhyvardia therapies

Can take 10 seconds to recharge
If it doesn’t work use emergency external defibrillation

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176
Q

EWSL ok with ppl with

A

Pacemakers

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177
Q

Need to reprogram pacemaker to asynchronous for

A

ECT

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178
Q

MRI generally contraindicated for ppl with

A

CIED

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179
Q

Two kinds of true aneurysms are saccular and fusiform

A

Saccular only involve a portion of the vessel

Fusiform involves diffuse, circumferential dilation of a long vascular segment

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180
Q

Aortic dissection presents when blood enters

A

Arterial wall through intimate tear

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181
Q

Biggest risk factor for aortic dissection is

A

Hypertension

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182
Q

Aneurysms can form from

A

Congenital bicuspid aortic valve or Turner syndrome

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183
Q

Type 1 aortic dissection starts in

A

Ascending aorta and extends throughout the aorta down to the common iliaca arteries

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184
Q

Type 2 aortic dissection is limited to the

A

Ascending aorta only

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185
Q

Type 3 dissection begins

A

Distal to the left subclavian artery

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186
Q

Main cause of death with an aneurysm is

A

Rupture

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187
Q

Cell saver induced loss of

A

Platelets, plasma proteins, coagulation factors

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188
Q

Left arterial to femoral bypass if prolonged aortic cross

A

Clamping

DHCA can help

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189
Q

One lung ventilation and two forms of temp and left heart bypass for

A

Thoracic aneurysm repair

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190
Q

TAAA can lead to

A

End organ ischemia
Aortic cross clamp time affects it

Can affect spinal cord most feared
Kidneys can also be affected- if age>50, preexisting renal problrms, duration renal ischemia>40 min, hemodynamic instability

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191
Q

Most common postop complication of TAAA repair (thoracic aneurysm) is

A

Postop respiratory failure

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192
Q

Synaptic pathway disruption

A

Decreased amplitude

Increased latency

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193
Q

MEPs look at

A

Anterior horn motor neurons of coryicospinal tract, both areas supplied by anterior spinal arteries

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194
Q

Aortic clamping

A

Proximal hypertension due to sudden increase in afterload
Increase in CVP
Increased preload afterload
Increased SVR and eventually cardiac output goes down

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195
Q

Aortic unclamping

A

Hypotension due to blood volume redistribution and pooling
Hypoxia mediated vasodilation with increased venous capacitance
Release of vasoactive and myocardial depressants mainly lactic acid

Hypoxemia
Acute metabolic acidosis which can decrease myocardial contractility

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196
Q

Most common access site for endovascular TAAA repair is

A

Femoral artery

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197
Q

Endovascular TAAA complications

A

Hypotension- aortic rupture, allergic reaction to contrast dye
Spinal cord ischemia
Postimplantation syndrome- fever, elevated C protein, leukocytosis- treatment is with NSAIDs

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198
Q

Single most common cause of early morbidity in AAA resection is an

A

MI

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199
Q

Major pathological cause of aneurysm is

A

Atherosclerosis

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200
Q

Surgical interventions best for aneurysms larger than

A

5.5cm

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201
Q

Reduce myocardial oxygen demand by avoiding

A

Tachycardia and HTN

Prevent hypotension and anemia

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202
Q

Greatest demand on heart comes from increased

A

HR

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203
Q

Single anterior spinal artery

A

Supplies 75% of the spinal cord

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204
Q

Artery of Adamkowitz

A

Supplies thoracolumbar region

Arises from T9-T12

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205
Q

It is possible to have paralysis with normal SSEPs and paralysis

A

Blood flow through anterior spinal artery not detected

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206
Q

Temp
Anesthetic depth
Changes in blood flow can alter

A

SSEPs

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207
Q

MEPs do monitor

A

Areas of spinal cord supplied by anterior spinal artery

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208
Q

AAA

A

Epidural helps

Regional May decrease hypercoaguability and thrombotic events

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209
Q

Put a line prior to anesthesia for

A

Triple A

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210
Q

Major complications arterial line placement

A

Vascular insufficient and infection

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211
Q

Invasive measure of volume status is needed if

A

Open AAA repair

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212
Q

How long to wait before epidural after giving LMWH

A

12 hours

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213
Q

Therapeutic dose like enoxaparin 1mg/kg wait

A

24 hours before epidural

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214
Q

Oral warfarin should be stopped

A

4 to 5 days before surgery

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215
Q

Remove neuraxial catheters when INR under

A

1.5

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216
Q

Aortic cross clamp can lead to

A

Arterial HTN with increase afterload and decreased CO

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217
Q

If post cross clamp get ST changes and high PCWP can give

A

Nitroglycerin to lower LVEDP and help with myocardial ischemia

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218
Q

Extubation criteria

A 
Vital capacity 15ml/kg
Ph greater than 7.3
Pac02 less than 50
NIF greater than -20
Stable hemodynamic
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219
Q

Adolescent
Early childhood
Infant

Normal BP

A

100/75
85/55
70/45

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220
Q

Hypertensive emergency

A

180/120 above with end organ damage

If not it’s urgent

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221
Q

Hyper dynamic hypertension

A

Postop surgical patient, acute systolic HTN, widened pulse pressure, increased CO, HR, SVR

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222
Q

Sign of long standing HTN

A

LVH which increases the risk of an MI

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223
Q

Diuretics lower BP by

A

Increasing urinary sodium excretion, and by reducing plasma volume, extracellular fluid volume, and cardiac output

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224
Q

Hydralazine nitroglycerin relax

A

Smooth muscle of resistance and capacitance vessels to different degrees

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225
Q

Should cancel surgery for high

A

BP

But if asymptomatic can usually proceed

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226
Q

Acute withdrawal of beta blockers could lead to

A

Ischemic myocardial events

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227
Q

Hypokalemia

A

Depresses neuromuscular function

Should check and if potassium below 3 try to replete before surgery

Can give potassium not exceeding 0.5 mEQ per kg of body weight per hour

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228
Q

Hypomagnesium can induce

A

Seizures, confusion, and coma

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229
Q

Bruit is a sign of

A

Vascular disease

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230
Q

U can give an

A

Antihypertensive before surgery

Usually beta blocker is best bc it will lower demand and risk of myocardial ischemia

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231
Q

Induction of Hypertensive pt

A

As ur preoxygenating give 7 to 8 ug per kg fentanyl then prop

Prob don’t give ketamine can cause HTN and tachycardia

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232
Q

During and immediately following intubation associated with tachycardia and HTN

A

Decrease in LVEf

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233
Q

Hypotension after induction usually due to

A

Hypovolemia, Vasodilation, and cardiac depression

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234
Q

Can give esmolol

A

Two minutes before Extubation if worries about HTN

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235
Q

Postop HTN causes

A 
Pain
Emergence excitement
Hypoxemia
Hypercarbia
Full bladder
Hypothermia
Withdrawal
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236
Q

SOB inability to lay supine oliguria post cardiac bypass think

A

Tamponade

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237
Q

CO is the product of

A

Stroke volume x HR

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238
Q

Stroke volume

A

Difference between left ventricular end diastolic and systolic volume

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239
Q

Cardiac tamponade

A

Extrinsic compression of the heart from intrapericardial blood and clots, exudative effusions, nonexidative effusions, and air

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240
Q

Significant chest tube output (more then 200ml per hour) immediate postop is a sign of

A

Increased amount of blood around the heart

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241
Q

Delayed tamponade

A

5 to 7 days after pericardotomy

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242
Q

Normal spontaneous inspiration

A

Extrathoracic to intrathoracic pressure gradient is increased and the filling of the right heart is slightly higher than the left

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243
Q

Kussmaul sign

A

Inspiratory fall of arterial BP increases 10mm Hg

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244
Q

As low as 150 ml acutely can lead to

A

Tamponade

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245
Q

With tamponade cardiac silhouette will be

A

Widened with water bottle configuration of the heart

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246
Q

Unfractionated heparin anticoagulant activity through

A

AT3

247
Q

LMWH

A

Inhibits factor 10a preferentially

248
Q

LMWH better with less bleeding than

A

Unfractionated heparin

249
Q

HIT

A

Immune mediated by complex between heparin and platelet factor 4

250
Q

HIT type 2

A

Life threatening 5 to 10 days after initiation of heparin therapy

Platelet count down 50% or less then 50000

251
Q

Hit type 2 treatment is

A

Discontinuation of heparin

Can use direct thrombin inhibitors or LMWH

252
Q

Heparin negatively charged

A

Protamine positively charged

253
Q

PT

A

Extrinsic pathway

254
Q

TEG measures

A

Physical properties of a clot

255
Q

Desmopressin helps with hemostasis by increasing

A

VWF and factor 7 activity in plasma

Best dose is 0.3 ucg/kg

Might be good in patients with ESRD with less vWF

256
Q

Pathological fibrinolysis is when

A

Fibrin in a thrombus is broken down before healing

257
Q

E aminocaproic acid and txa are analogues of

A

Lysine

They inhibit plasminogen and plasmin, resulting in less fibrinogen or fibrinolysis

258
Q

Standard IV for cardiac surgery dose of Aminocaproic acid

A

5 to 10g follower by infusion of 1g per hour

259
Q

Can give fluid in tamponade even if

A

CVP is high but PAOP is low

260
Q

Inotropy with vasodilation properties

A

Milrinone/dobutamine

261
Q

FFP contains

A

Labels factors 5 and 8 as well as stable coagulation factors 2,7,9,10

262
Q

Cryoprecipitate contains

A

Factors 8,13, vWf and fibrinogen

263
Q

FFP indications

A

Replacement of factor deficiencies
Reversal of warfarin
Massive blood transfusions
Treatment of antithrombin 3 deficiency in patients who are heparin resistant

264
Q

Platelet concentrate indications

A

Active bleeding associated with thrombocytopenia

Massive blood transfusions

265
Q

Cryoprecipitate indications

A

Bleeding patients with VWF
Correction of microvascular bleeding in massively transfused patients with fibrinogen concentrations less than 80 to 100 mg per dl

266
Q

One unit of cryoprecipitate per 10kg body weight

A

Raises plasma fibrinogen concentration approximately 50 mg per dl

267
Q

Risk of HIV when giving blood is

A

1/500000 for each unit given

268
Q

Most common virus transmitted via blood transfusion is

A

CMV

269
Q

Preop tamponade give

A

Supplemental O2
Check chest radiograph
Assess Abg

270
Q

IV ketamine 1mg/kg has a rapid onset

A

Achieves peak plasma concentration in less than 1 minute

Indirectly depresses the myocardium

271
Q

Fentanyl May decrease

A

BP

272
Q

Etomidate best during induction when

A

Cardiovascular collapse is anticipated

273
Q

Cardiac tamponade induction

A

Have surgical team at bedside with drapes up

Fentanyl
Neuromuscular blocker
Etomidate/Ketamine

274
Q

Negative pressure to positive pressure after intubation causes

A

Reduced cardiac filling by increasing intrathoracic pressure and afterload

Lower tidal volume will help with filling

275
Q

In tamponade chest opening

A

Normalizes the pressure relation and can see improvement immediately

276
Q

Labetalol antagonizes both

A

Alpha and beta receptors

277
Q

Most common reasons for heart transplant

A

Ischemic coronary artery disease and nonischemic cardiomyopathy

278
Q

Peak V02 max < 10 ml/kg/min indication for

A

Transplantation

279
Q

Can’t donate heart if

A

EF<40% or bad LVH with wall thickness>13mm

280
Q

Diabetes insipidus is seen in brain dead donors with urine output of more then 300 ml/hr and have to give

A

Desmopressin

281
Q

Most common cause of death within 30 days of transplant

A

Graft failure, multi organ failure, non CMV

282
Q

31 to 365 days post transplant cause of death

A

Non CMV

Graft failure, acute rejection

283
Q

Biatrial vs bicaval technique

A

Biatrial involves anastomosis if recipient and donor atrial cuffs

Bicaval maintains above left anastomoses and attempts to maintain cardiac anatomy with desperate bicaval anastomoses to the right atrium

284
Q

LVAD insertion reasons

A

Cardiogenic shock
Progressive decline
Inotropy dependence

285
Q

Excessive afterload can hinder

A

LVAD

286
Q

For heart transplant should reach CP bypass

A

At time of donor heart arrival to minimize ischemic time

287
Q

Avoid nitrous oxide in heart transplant

A

Due to its effects on PVR

288
Q

Place patient in head down position for

A

Air evacuation from left side of heart

289
Q

Can give what drug to increase HR and contractility in heart transplant

A

Isoproterenol

290
Q

Early postop complications of heart transplant

A

Right heart failure/pulmonary HTN
Denervated heart
Bleeding
Early graft failure

291
Q

Inhaled No

A

Selective pulmonary vasodilator in severe pulmonary HTN and RV failure

292
Q

Following cardiac transplant

A

Cardiac plexus is interrupted and the heart is deenervated

293
Q

Deenervated heart

A

Lacks ability to respond to acutely your hypovolemia or hypotension with reflex tachycardia but responds to stress with increase in stroke volume

This is why heart transplant patients are preload dependent

294
Q

Within 30 days after heart transplant most common cause of death is

A

Graft failure

295
Q

Neostigmine can cause

A

Dose dependent decrease in heart rate in heart transplanted patients

296
Q

Cardiac dysrhythmias can occur in

A

Heart transplant patients

297
Q

Gold standard to check for allograft rejection

A

Endomyocardial biopsy

Mainly treated with steroids

298
Q

Chronic steroid treatment results in abnormal stress response so patients should receive

A

Perioperative steroids

299
Q

Transplanted heart is vulnerable to accelerated process of coronary atherosclerosis called

A

Cardiac allograft vasculopathy

300
Q

Most heart transplant patients get renal function from using

A

Cyclosporine

301
Q

Prolonged ST depression check

A

Troponins

Elevation may start within the first 8 hours post surgery

302
Q

Peak incidence of cardiac disease is within the

A

First 3 days of surgery

303
Q

Beta blockers

A

Reduce myocardial oxygen consumption
Improves coronary blood flow
Improves supply/demand
Improves oxygen dissociation from Hgb

304
Q

Nitrates

A

Decreased LV preload
Systemic venous dilation
Decreased LV afterload
Coronary artery and arteriolar dilation

305
Q

Calcium channel blockers

A

Reduce myocardial oxygen demand By depression of myocardial contractility and dilation of coronary and collateral vessels, improving blood flow

306
Q

Aspirin inhibits platelet aggregation by blocking production of

A

Thromboxane A2

307
Q

Alpha 2 agonists stimulate pre junctional alpha receptors and

A

Decrease norepinephrine release

308
Q

PAC is an insensitive for

A

MI

309
Q

Hypotension
Hypertension
Tachycardia can lead to

A

MI

310
Q

Etomidate

A

0.2 to 0.3 mg/kg for induction

311
Q

During cardiac surgery if you get a new 3mm st segment depression in lead V5

A

HR control and adequate coronary perfusion pressure

Avoid hypotension
Correct anemia
Correct shivering to lower oxygen demand

312
Q

Calcium channel blockers drug of choice for

A

Coronary spasm

313
Q

Recommended HR for high risk patients

A

60 to 70

Definitely less than 100

314
Q

To prevent tachycardia and HTN of emergence of cardiac patient can give

A

1 mg/kg lidocaine or esmolol or .1 mg/kg of labetalol

315
Q

Visceral pain

A

C fibers which is dull and crampy

316
Q

Most common cause of intestinal obstructions

A

Adhesions then hernia

317
Q

Four cardinal signs of intestinal obstruction

A

Crampy abdominal pain
Nausea and vomiting
Obstipation,
Abdominal distension

318
Q

Ileus

A

Functional failure of normal intestinal transit

319
Q

Need to decompress abdomen

A

For ileus beforehand

320
Q

Most important factors post aspiration

A

Volume
Ph of gastric content
Presence or abscence of particulate

321
Q

Incomplete LES increases the likelihood of

A

Regurg and aspiration

322
Q

Aspiration of gastric contents leads to

A

Chemical pneumonitis with
Hypoxemia
Bronchospasm
Atelectasis

323
Q

Once vomiting or regurgitation occurs

A

Lateral head down
Suction
Trachea suctioned

Bronchoscopy for patients who aspirated solids leading to significant airway obstruction

324
Q

Liver transplant donor types

A

Donation after cardiac death(DCD)
Partial livers from living donors
Harvesting marginal donors from cadevers

325
Q

Candidates for liver transplant

A

Acute liver failure
Decompensated cirrhosis
Hepatocellular carcinoma

326
Q

Most common indication for pediatric liver transplant is

A

Biliary atresia

327
Q

Portopulmonary HTN

A

Mean pulmonary artery pressure>25 at rest

Pulmonary vascular resistance >240

328
Q

As cirrhosis progresses you get a decrease in

A

SVR

Leading to compensatory activation of RAS leading to ascites, edema, and vasoconstriction of the intrarenal circulation and renal hypoperfusion

329
Q

Cirrohsis leads to

A

Hypervolemic hyponatremia from increased secretion of ADH thus leading to expanded extracellular volume, ascites and edema

Impairs excretion of solute free water

330
Q

Hepatorenal syndrome

A

Renal vasoconstriction in response to systemic vasodilation.

Cirrohsis with ascites
Creatinine>1.5
Abscence of shock
No current nephrotoxic meds

Type 1 is rapid with doubling of serum creatinine

331
Q

Hepatopulmonary syndrome

A

Platypnea (dyspnea in upright position better by laying down)

332
Q

Ascites initially managed with

A

Low sodium diet
Diuretics

Next step is paracentesis and albumin replacement

333
Q

During TIPS procedure expendable stent is placed in liver

A

Parenchyma to decrease portal HTN

334
Q

In patients with liver disease muscle relaxant doses are

A

Increased because fluid retention increases volume of distribution

335
Q

Presence of coagulopathy is a contraindication to

A

Regional anesthesia especially epidural anesthesia

336
Q

Preanhepatic phase

A

Induction of anesthesia ends with clamping of hepatic artery

337
Q

Second phase

A

Anhepatic phase begins after removal of diseased liver and ends with reperfusion of the new liver

Clamp and divide the IVC

338
Q

Without a liver

A

Patient may get acidosis and hypocalcemia bc lactic and citrate not cleared

339
Q

Venovenous bypass

A

Divert blood flow from portal circulation and IVC to the right atrium

340
Q

In anhepatic phase

A

Gluconeogenesis is absent

341
Q

Removal of suprahepatic IVC doesn’t cause any changes but unclamping of the infrahepatic IVC restores

A

Venous return

342
Q

After unclamping of portal vein

A

Desaturated blood goes into systemic circulation leading to decrease in BP, HR, SVR, CO etc

343
Q

Hyperkalemia treatment

A

Diuretics, beta agonists, insulin, alkalinization with sodium bircarb or hyperventilation

344
Q

Anticipate hypocalcemia with liver disease due to failure to clear

A

Citrate

345
Q

Lethal triad

A

Coagulopathy
Acidosis
Hypothermia

346
Q

Potential disadvantages of antifibrinolytics such as TXA are

A

Development of thromboses that could be catastrophic

347
Q

Intraoperative signs a graft is working

A

Good texture and color
Bile production
Hemodynamic stability

348
Q

A functioning graft liver might not function for

A

Days so many need clotting factors in early postop period

349
Q

Cerebral perfusion pressure

A

MAP-ICP or CVP whichever is higher

350
Q

Posterior fossa tumors

A

In contact with cranial nerves and brainstem nuclei so need to be very careful

351
Q

Intracranial HTN treatments

A 
Corticosteroids
Head elevation
Diuretics
Hypertonic saline
Hyperventilation 
Ventriculostomy usually clamped on transport
Drug induced cerebral vasoconstriction and coma with thiopental 
Deliberate hypothermia
352
Q

Sitting position leads to decreased

A

Preload so need fluids

353
Q

Central access is needed for giving

A

Hypertonic saline

354
Q

Giving sodium bicarbonate lowers

A

Potassium

355
Q

For peds advocate to give

A

20 to 40 ml per kg of an isotonic fluid over course of anesthetic

356
Q

Analgesic effects of methadone last

A

4-8 hours

357
Q

Methadone is a full agonist at

A

U receptors

358
Q

In ESRD a decrease of

A

50 to 75% of methadone dosage is needed

359
Q

Methadone black box warnings

A

Death from respiratory depression
Cardiac effects
Arrhythmias such as torsades

360
Q

Propofol decreases the dissociation of GABA and

A

It’s receptor

361
Q

GABA and chloride ion come closer together with

A

Benzodiazepines

362
Q

Carotid disease

A

Asynptomatic bruit or TIA

363
Q

Accepted indications for carotid surgery include

A

TIA with angio evidence of stenosis
Reversible ischemic neurologic deficits with greater than 70% stenosis of vessel wall
Unstable neurologic status persisting despite anticoagulation

364
Q

Right common carotid off

A

Brachiocephslic trunk

Left comes off aortic arch

365
Q

Common carotid bifurcates into internal and external carotids at

A

Thyroid cartiledge

366
Q

If after carotid endarterectomy the intima is too thin can close the vessel with a

A

Vein graft or a synthetic(dacron) graft

367
Q

Normal CBF is

A

50 ml/100g/min for the entire brain

368
Q

At pressures less then 50mm Hg cerebral vessels are maximally vasodilator, so that CBF decreases as

A

MAP falls

369
Q

Chronically ischemic vascular beds are maximally vasodilated and can not

A

Dilate further in response to hypercapnea

370
Q

EEG tells you if certain areas of the brain are at risk for

A

Infarction

371
Q

Advantage of regional anesthesia during carotid endarterectomy is

A

Repeated neurologic exams

372
Q

Regional anesthesia can lead to

A

Seizures
Alteration of mental status with cerebral ischemia
Loss of patient cooperation associated with cerebral hypoperfusion

373
Q

Deep or cervical plexus blocks can get

A

C2-C4 for a carotid endarterectomy

374
Q

Reperfusion injury involves

A

Cerebral hemorrhage or the development of cerebral edema after obstruction to flow through the carotid artery has been relieved

375
Q

Amiodarone

A

Pneumonitis

Causes fibrosis and decrease in DLCO

Maintain lowest amount of Fi02 possible

376
Q

Amiodarone can cause

A

Pulmonary fibrosis
Liver dysfunction and hepatitis
Hypo and hyperthyroidism

377
Q

Lesions in eloquent cortex don’t require

A

Lumbar drain

Lesions are too small

378
Q

VAE associate with

A

Posterior fossa craniotomy and cervical spine surgery

379
Q

Small doses of Propofol 10 mg will suffice to

A

Stop seizure during awake craniotomy

380
Q

Loading dose of precedex

A

1 ug per kg over 10 minutes before maintenance infusion

381
Q

Treat seizures with

A

Benzodiazepines

382
Q

Primary vs secondary injury

A

Primary is due to initial impact

Secondary is what happens after the impact

383
Q

Mannitol

A

.25 to 1 g per kg

Reduces ICP after 15 minutes

384
Q

Stress response after severe head injury

A

Release of catecholamines and hyperglycemia

385
Q

Severe hyponatremia below 120 can lead to

A

Cerebral edema and seizures

386
Q

Magnesium falls during

A

TBI

387
Q

Decimpressive crani

A

Decrease high ICP due to brain edema

First line is moderate hypocapnia, mannitol, sedation, normothermia

388
Q

Palpate to look for

A

Cervical spine injury

389
Q

Give defasicukating dose before giving

A

Succ so ICP doesn’t go up

390
Q

Hyperventilation for control of

A

ICP and reversal of acidosis in brain tissue

391
Q

Corticosteroids help with

A

Cortical vasogenic edema

392
Q

Control ICP with

A

Hyperventilation
Head up tilt
CSF drainage
Mannitol

393
Q

Seizures

A

Increase ICP

394
Q

Tylenol first line for

A

Fever

395
Q

Any malpractice payments made on behalf of an individual physician must be reported to the

A

NPDB

396
Q

Part 4 mocha requirement can be achieved with

A

Creating a quality improvement plan

397
Q

Nitrous oxide

A

Irreversibly binds to and oxidizes cobalt in Vitamin b12, converting it to an inactive state

398
Q

To make thyroid hormone you need

A

Iodine

399
Q

T3 much shorter half life than

A

T4

90% of hormone released from thyroid gland is T4

400
Q

Thyroid increases

A

Cholesterol secretion into bile

401
Q

90% of all hyperthyroidism is from

A

Graves’ disease

402
Q

Iodine can’t be given to

A

Children

Pregnant women or breast feeding

403
Q

Methimazole can be given rectally

A

Rectal

404
Q

Treat thyroid storm with

A

Beta blockers

405
Q

Malignant hyperthermia

A

Hypercarbia
Metabolic acidosis
Muscle rigidity

406
Q

Tracheomalacia make sure vocal cords are

A

Moving and airway doesn’t collapse

407
Q

Don’t use aspirin for

A

Thyroid storm

408
Q

Thyroid storm usually happens

A

6 to 18 hours post surgery

409
Q

Dislodgement of bronchial blocker into trachea causes

A

Higher peak pressures and sp02 to decrease

410
Q

Obese patients have more

A

Acetylcholinesterasse

411
Q

Ascites leads to

A

Restrictive lung disease

No change in FEV1/FVC ratio

412
Q

Acute drop in ICP from reduction in CSF volume can lead to

A

Cerebral aneurysm rupture with subarachnoid hemorrhage

413
Q

Transmural pressure across aneurysm is

A

MAP-ICP

414
Q

Pancreatic grafts require

A

Constant blood flow. Graft thrombosis should get reexplored

415
Q

Definitive treatment for DM is

A

Pancreas transplant

416
Q

Patients with peripartum cardiomyopathy should be offered a trial of

A

Vaginal delivery

417
Q

What influences the spread of spinal anesthesia with plain bupivicaine

A

CSF volume

418
Q

Bupivicaine and ropivicaine are isobaric

A

Most affected by CSF fluid volume

419
Q

Nitrous oxide can ignite so shouldn’t be used in

A

Laser airway surgery

420
Q

Halogenated gases are considered

A

Greenhouse gases

421
Q

Sudden sustained increase in BP is a sign of

A

Aneurysm rupture

422
Q

Gold standard for cerebral vasospasm diagnosis is

A

Angiography

423
Q

Primary hyperthyroidism due to

A

T3

424
Q

FRC

A

Amount of air in the lungs after a normal respiration

425
Q

Previous vaginal delivery doesn’t lead to

A

Uterine rupture

426
Q

Increased intrabdominal pressure from pneumopetitoneum from laporoscopic pressure can lead to

A

Outflow of CSF fluid being reduced from a shunt

427
Q

MA value down give

A

Platelets

428
Q

Before surgery on patients with type 1 VWF give

A

Desmopressin

429
Q

SV02

A

Percentage of oxygen bound to hemoglobin returning to right side of heart

430
Q

Measure SV02 at the

A

PAC

431
Q

Respiration less efficienct in infants due to

A

Highly compliant chest wall

432
Q

Stellate ganglion block is performed at

A

C6 level even though ganglion lies at C7

433
Q

Multiple groups categorical data is

A

Chi square

434
Q

Accuracy which a sample represents piopulstion is

A

Standard error of the mean

435
Q

90 percent of pheos are found in

A

Adrenal medulla

436
Q

Adrenal medulla secretes

A

Epinephrine, norepinephrine, dopamine

437
Q

Most endogenous catecholamine termination is by

A

Reuptake

438
Q

Severe headache diaphoresis palpitations think

A

Pheo

439
Q

Plasma metanephrines best for diagnosis of a

A

Pheo

440
Q

Morphine curare atracurium cause

A

Histamine release

441
Q

Norepinephrine and fluids may be needed after

A

Pheo removed

442
Q

Diagnosis of diabetes

A

Symptoms plus random glucose>200
HemoglobinA1c>6.5%
Fasting glucose>126
Two hour plasma glucose>200

443
Q

Met form in

A

Increased peripheral uptake of glucose by tissues

444
Q

Worsened neurologic and cardiac problems and wound healing with

A

Diabetes and high glucose during surgery

445
Q

Glucose above 180 causes

A

Protein glycation and osmotic diuresus

446
Q

Hemodynamic collapse associated with

A

Hypoglycemia

447
Q

Placenta percreta is

A

The most dangerous

Placenta through the myometrium with possible into other adjacent structures

448
Q

Nd YAG laser can lead to fatal

A

Gas embolus

449
Q

Caudal epidural for

A

Lower abdomen and lower extremity surgery

450
Q

Ropivicaine toxic dose is above

A

3 mg/kg

451
Q

Can’t get the FRC with

A

Spirometry

452
Q

Following smoking cessation there is actually an

A

Increase in sputum production

453
Q

Thiazides inhibit sodium transport in the

A

Distal convoluted tubule

454
Q

Lasix diuresis occurs within 5 minutes and lead effect by

A

1 hour

455
Q

Can do left hepatectomy to give liver to

A

Child which is an easier technique for the surgeon

456
Q

Lumbar nerve roots exit from the

A

Same numbered pedicle

457
Q

HCTZ acts on Na/Cl transporter

A

For HTN and edema

458
Q

Continue anti angina meds and beta blockers until

A

Day of surgery

459
Q

Dilution also hyponatremia occurs during a

A

TURP

Best fluid is normal saline

460
Q

TURP syndrome patient can go

A

Unresponsive

461
Q

Several liters of bladder irrigation pass through during

A

TURP

Can lower body temperature a good amount

462
Q

TURP syndrome due to large volume mainly hypotonic bladder irrigation

A

Can lead to CNS, hematologists, renal, etc

Headache nausea SOB are early signs

463
Q

Respiratory and CV arrest if

A

Serum sodium less than 110

464
Q

If TURP syndrome

A

Terminate surgery
Administer 20mg lasix
Oxygen
Get blood gas

465
Q

Glycine is an

A

Inhibitory neurotransmitter

Can be toxic to heart and retina

466
Q

Hyperglycemia

A

Can cause transient visual disturbance during TURP

467
Q

TURP similar to

A

Hysteroscopy

468
Q

Cos atracurium

A

Hoffman elimination

469
Q

Hiv can get

A

Renal transplant if low cd4 count but not aids patient

470
Q

Prolonged neuromuscular blockade with

A

Renal disease

471
Q

Increased neuromuscular blockade

A 
Abx like aminoglycosides
Local anesthetics 
Lasix
Lithium
Hypermagnesium 
Hypothermia
472
Q

Hypotension May occur during kidney transplant after unclamping the iliaca vessel and

A

Reperfusion of the graft

473
Q

Far less diaphragm loss and pulmonary loss with

A

Laparoscopic surgery

474
Q

Laparoscopic surgery is ok in

A

Pregnant patient

475
Q

C02 is insufflation has of choice bc

A

Nonflammable, rapidly removed from lungs, highly soluble bc of rapid buffering in whole blood

476
Q

200 ml of CO2 is made per

A

Day

477
Q

Convert laparoscopy to laparotomy if

A

Major bleeding or organ damage

478
Q

Hypercarbia leads to

A

Depression of myocardial contractility and rate of contraction

479
Q

Intraabdomen pressure greater than 30

A

Decrease in BP cardiac output CVP due to pressure on vena cava leading to decrease venous return

480
Q

C02 crosses

A

BBB not H+

481
Q

Painlessvaginal bleedingthink

A

Previa

Don’t do digital exam bc if previa leads to hemorrhage

Do transvaginal US first

482
Q

To prevent graft vs host need to

A

Irradiate blood

483
Q

Lumbar plexus sympathy blocks for crps

A

May cause ejaculation problems

484
Q

SEM

A

SD/square root sample size

485
Q

Loop and thiazides cause

A

Hypochloremic metabolic alkalosis

486
Q

Brachial artery runs in close proximity to

A

Median nerve

487
Q

IABP through femoral artery into

A

Descending aorta

488
Q

Oliguria

A

<0.5 ml/kg/hr

489
Q

Anuria

A

Less than 50 ml/day

490
Q

Internal branch of superior laryngeal nerve sensation to entire

A

Larynx above the glottis

491
Q

Most appropriate initial drug for shoulder dystocia is

A

Nitroglycerin

492
Q

Child over 12 mo has blood volume

A

70-75 ml/kg

493
Q

To prevent rebreathing fresh gas flow must be

A

1-2 times minute ventilation in the Mapleson D semi open breathing system

494
Q

PEEP can worsen

A

Increased PVR and mean airway pressures

495
Q

Risk for uterine rupture higher with previous

A

C section

496
Q

Oxytocin increases frequency and

A

Duration of uterine contractions

497
Q

Acute stretching of peritoneum by abdominal insufflation can lead to

A

Huge Vagal response

498
Q

Hydrocortisone lowers

A

NMB potential

499
Q

Single most common sign of fetal compromise

A

Reduced beat to beat variability

500
Q

Potential disadvantages of antifibrinolytics such as TXA are

A

Development of thromboses that could be catastrophic

501
Q

Intraoperative signs a graft is working

A

Good texture and color
Bile production
Hemodynamic stability

502
Q

A functioning graft liver might not function for

A

Days so many need clotting factors in early postop period

503
Q

Cerebral perfusion pressure

A

MAP-ICP or CVP whichever is higher

504
Q

Posterior fossa tumors

A

In contact with cranial nerves and brainstem nuclei so need to be very careful

505
Q

Intracranial HTN treatments

A 
Corticosteroids
Head elevation
Diuretics
Hypertonic saline
Hyperventilation 
Ventriculostomy usually clamped on transport
Drug induced cerebral vasoconstriction and coma with thiopental 
Deliberate hypothermia
506
Q

Sitting position leads to decreased

A

Preload so need fluids

507
Q

Central access is needed for giving

A

Hypertonic saline

508
Q

Giving sodium bicarbonate lowers

A

Potassium

509
Q

For peds advocate to give

A

20 to 40 ml per kg of an isotonic fluid over course of anesthetic

510
Q

Analgesic effects of methadone last

A

4-8 hours

511
Q

Methadone is a full agonist at

A

U receptors

512
Q

In ESRD a decrease of

A

50 to 75% of methadone dosage is needed

513
Q

Methadone black box warnings

A

Death from respiratory depression
Cardiac effects
Arrhythmias such as torsades

514
Q

Propofol decreases the dissociation of GABA and

A

It’s receptor

515
Q

GABA and chloride ion come closer together with

A

Benzodiazepines

516
Q

Carotid disease

A

Asynptomatic bruit or TIA

517
Q

Accepted indications for carotid surgery include

A

TIA with angio evidence of stenosis
Reversible ischemic neurologic deficits with greater than 70% stenosis of vessel wall
Unstable neurologic status persisting despite anticoagulation

518
Q

Right common carotid off

A

Brachiocephslic trunk

Left comes off aortic arch

519
Q

Common carotid bifurcates into internal and external carotids at

A

Thyroid cartiledge

520
Q

If after carotid endarterectomy the intima is too thin can close the vessel with a

A

Vein graft or a synthetic(dacron) graft

521
Q

Normal CBF is

A

50 ml/100g/min for the entire brain

522
Q

At pressures less then 50mm Hg cerebral vessels are maximally vasodilator, so that CBF decreases as

A

MAP falls

523
Q

Chronically ischemic vascular beds are maximally vasodilated and can not

A

Dilate further in response to hypercapnea

524
Q

EEG tells you if certain areas of the brain are at risk for

A

Infarction

525
Q

Advantage of regional anesthesia during carotid endarterectomy is

A

Repeated neurologic exams

526
Q

Regional anesthesia can lead to

A

Seizures
Alteration of mental status with cerebral ischemia
Loss of patient cooperation associated with cerebral hypoperfusion

527
Q

Deep or cervical plexus blocks can get

A

C2-C4 for a carotid endarterectomy

528
Q

Reperfusion injury involves

A

Cerebral hemorrhage or the development of cerebral edema after obstruction to flow through the carotid artery has been relieved

529
Q

Amiodarone

A

Pneumonitis

Causes fibrosis and decrease in DLCO

Maintain lowest amount of Fi02 possible

530
Q

Amiodarone can cause

A

Pulmonary fibrosis
Liver dysfunction and hepatitis
Hypo and hyperthyroidism

531
Q

Lesions in eloquent cortex don’t require

A

Lumbar drain

Lesions are too small

532
Q

VAE associate with

A

Posterior fossa craniotomy and cervical spine surgery

533
Q

Small doses of Propofol 10 mg will suffice to

A

Stop seizure during awake craniotomy

534
Q

Loading dose of precedex

A

1 ug per kg over 10 minutes before maintenance infusion

535
Q

Treat seizures with

A

Benzodiazepines

536
Q

Primary vs secondary injury

A

Primary is due to initial impact

Secondary is what happens after the impact

537
Q

Mannitol

A

.25 to 1 g per kg

Reduces ICP after 15 minutes

538
Q

Stress response after severe head injury

A

Release of catecholamines and hyperglycemia

539
Q

Severe hyponatremia below 120 can lead to

A

Cerebral edema and seizures

540
Q

Magnesium falls during

A

TBI

541
Q

Decimpressive crani

A

Decrease high ICP due to brain edema

First line is moderate hypocapnia, mannitol, sedation, normothermia

542
Q

Palpate to look for

A

Cervical spine injury

543
Q

Give defasicukating dose before giving

A

Succ so ICP doesn’t go up

544
Q

Hyperventilation for control of

A

ICP and reversal of acidosis in brain tissue

545
Q

Corticosteroids help with

A

Cortical vasogenic edema

546
Q

Control ICP with

A

Hyperventilation
Head up tilt
CSF drainage
Mannitol

547
Q

Seizures

A

Increase ICP

548
Q

Tylenol first line for

A

Fever

549
Q

Any malpractice payments made on behalf of an individual physician must be reported to the

A

NPDB

550
Q

Part 4 mocha requirement can be achieved with

A

Creating a quality improvement plan

551
Q

Nitrous oxide

A

Irreversibly binds to and oxidizes cobalt in Vitamin b12, converting it to an inactive state

552
Q

To make thyroid hormone you need

A

Iodine

553
Q

T3 much shorter half life than

A

T4

90% of hormone released from thyroid gland is T4

554
Q

Thyroid increases

A

Cholesterol secretion into bile

555
Q

90% of all hyperthyroidism is from

A

Graves’ disease

556
Q

Iodine can’t be given to

A

Children

Pregnant women or breast feeding

557
Q

Methimazole can be given rectally

A

Rectal

558
Q

Treat thyroid storm with

A

Beta blockers

559
Q

Malignant hyperthermia

A

Hypercarbia
Metabolic acidosis
Muscle rigidity

560
Q

Tracheomalacia make sure vocal cords are

A

Moving and airway doesn’t collapse

561
Q

Don’t use aspirin for

A

Thyroid storm

562
Q

Thyroid storm usually happens

A

6 to 18 hours post surgery

563
Q

Dislodgement of bronchial blocker into trachea causes

A

Higher peak pressures and sp02 to decrease

564
Q

Obese patients have more

A

Acetylcholinesterasse

565
Q

Ascites leads to

A

Restrictive lung disease

No change in FEV1/FVC ratio

566
Q

Acute drop in ICP from reduction in CSF volume can lead to

A

Cerebral aneurysm rupture with subarachnoid hemorrhage

567
Q

Transmural pressure across aneurysm is

A

MAP-ICP

568
Q

Pancreatic grafts require

A

Constant blood flow. Graft thrombosis should get reexplored

569
Q

Definitive treatment for DM is

A

Pancreas transplant

570
Q

Patients with peripartum cardiomyopathy should be offered a trial of

A

Vaginal delivery

571
Q

What influences the spread of spinal anesthesia with plain bupivicaine

A

CSF volume

572
Q

Bupivicaine and ropivicaine are isobaric

A

Most affected by CSF fluid volume

573
Q

Nitrous oxide can ignite so shouldn’t be used in

A

Laser airway surgery

574
Q

Halogenated gases are considered

A

Greenhouse gases

575
Q

Sudden sustained increase in BP is a sign of

A

Aneurysm rupture

576
Q

Gold standard for cerebral vasospasm diagnosis is

A

Angiography

577
Q

Primary hyperthyroidism due to

A

T3

578
Q

FRC

A

Amount of air in the lungs after a normal respiration

579
Q

Previous vaginal delivery doesn’t lead to

A

Uterine rupture

580
Q

Increased intrabdominal pressure from pneumopetitoneum from laporoscopic pressure can lead to

A

Outflow of CSF fluid being reduced from a shunt

581
Q

MA value down give

A

Platelets

582
Q

Before surgery on patients with type 1 VWF give

A

Desmopressin

583
Q

SV02

A

Percentage of oxygen bound to hemoglobin returning to right side of heart

584
Q

Measure SV02 at the

A

PAC

585
Q

Respiration less efficienct in infants due to

A

Highly compliant chest wall

586
Q

Stellate ganglion block is performed at

A

C6 level even though ganglion lies at C7

587
Q

Multiple groups categorical data is

A

Chi square

588
Q

Accuracy which a sample represents piopulstion is

A

Standard error of the mean

589
Q

90 percent of pheos are found in

A

Adrenal medulla

590
Q

Adrenal medulla secretes

A

Epinephrine, norepinephrine, dopamine

591
Q

Most endogenous catecholamine termination is by

A

Reuptake

592
Q

Severe headache diaphoresis palpitations think

A

Pheo

593
Q

Plasma metanephrines best for diagnosis of a

A

Pheo

594
Q

Morphine curare atracurium cause

A

Histamine release

595
Q

Norepinephrine and fluids may be needed after

A

Pheo removed

596
Q

Diagnosis of diabetes

A

Symptoms plus random glucose>200
HemoglobinA1c>6.5%
Fasting glucose>126
Two hour plasma glucose>200

597
Q

Met form in

A

Increased peripheral uptake of glucose by tissues

598
Q

Worsened neurologic and cardiac problems and wound healing with

A

Diabetes and high glucose during surgery

599
Q

Glucose above 180 causes

A

Protein glycation and osmotic diuresus

600
Q

Hemodynamic collapse associated with

A

Hypoglycemia

601
Q

Placenta percreta is

A

The most dangerous

Placenta through the myometrium with possible into other adjacent structures

602
Q

Nd YAG laser can lead to fatal

A

Gas embolus

603
Q

Caudal epidural for

A

Lower abdomen and lower extremity surgery

604
Q

Ropivicaine toxic dose is above

A

3 mg/kg

605
Q

Can’t get the FRC with

A

Spirometry

606
Q

Following smoking cessation there is actually an

A

Increase in sputum production

607
Q

Thiazides inhibit sodium transport in the

A

Distal convoluted tubule

608
Q

Lasix diuresis occurs within 5 minutes and lead effect by

A

1 hour

609
Q

Can do left hepatectomy to give liver to

A

Child which is an easier technique for the surgeon

610
Q

Lumbar nerve roots exit from the

A

Same numbered pedicle

611
Q

HCTZ acts on Na/Cl transporter

A

For HTN and edema

612
Q

Retinopathy of prematurity usually not important after

A

44 wks

613
Q

Lateral femoral cutaneous nerve contains fibers from the

A

L2-L3

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