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truelearn advanced exam > Truelearn first pass > Flashcards

Truelearn first pass Flashcards

1
Q

Correction of DKA

A

1st. FLUIDS! hydrate
2. Insulin
3. Monitor K throughout

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2
Q

Lab to monitor for DKA

A

q1h glucose
q4h BMP, plasma osmolality, venous pH
progress: beta-hydroxybutyrate and anion gap

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3
Q

Correction rate of glucose for DKA

A

less than 100 per hour
-brain needs to adapt to changes in plasma osmolality
-if corrected too quickly -> cerebral edema

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4
Q

Where to block superficial cervical?

A

midpoint of posterior border of SCM

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5
Q

What does superficial cervical block cover?

A

Surgeries w/ neck, anterior shoulder, and clavicle
-distribution of C2-4

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6
Q

Superifical cervical block

A
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7
Q

Hypoplastic L heart blood circulation

A

dpt on PDA for systemic BF
-balance b/w pulm and systemic BP

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8
Q

What happens when pt w/ hypoplastic L heart induced w/ 100% FiO2 -> hypoTN

A

-if dec in PVR -> more blood shunted to pulm not body -> dec in BP -> shock

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9
Q

Goal SpO2 of hypoplastic L heart

A

85% -> keep inc PVR

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9
Q

Goal SpO2 of hypoplastic L heart

A

85% -> keep inc PVR

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10
Q

Determinants of PVR

A

PaO2 (hypoxic pulm vasoconstriction)
PaCO2 (hypercarbic constriction)
temp
intrathoracic pressure

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11
Q

Vent changes to inc PVR

A

Dec FiO2
Dec minute ventilation
inc intrathoracic pressure

To dec PVR:
augment w/ preload optimizations and milrinone

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12
Q

Order of repair for hypoplastic L heart syndrome

A

Not Gonna Fly
Norwood
Glenn
Fontan

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13
Q

pregnant pt w/ CP, hemoptysis, dyspnea

A

PE

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14
Q

Pregnant pt concern for PE,normal CXR, what confirmatory test?

A

V/Q scan

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15
Q

Pregnant pt concern for PE, abnormal CXR, what confirmatory test?

A

CT pulm angiography

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16
Q

Supraglottic jet ventilation
-where to attach
-disadvantages

A

instrument, used for surgeries w/ proximal airway structures
-greater movement of VC
-requires precise alignment of jet w/ axis of trachea
-entrains more ambient air
-no reliable EtCo2
-greater risk of jetting airway contaminants (purulent material, surgical smoke, blood, other debris)

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17
Q

What is jet ventilation

A

High pressure bursts of gas into airway -> low TV w/ passive expiration

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18
Q

What do we set for jet ventilation

A

Driving pressure
Inspiratory time
Respiratory rate

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19
Q

Complications of jet ventilation

A

barotrauma
air trapping
hypercapnia
PTX

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20
Q

Subglottic jet ventilation
-advantages

A

-lowe rairway pressures
-tighter control over O2 concentration
-improved EtCO2 monitoring
-minimal airway contamination

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21
Q

Subglottic jet ventilation
-disadvantages

A

req special catheter be inserted past VC -> can impair surgeons view

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22
Q

High-freq jet ventilation
-what is it?

A

Automated mode
-inspirations at supraphysiologic rates (up to 300 per minute)
-motionless pt
-assessment of ventilation hard, and expensive

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23
Q

Low-freq jet ventilation

A

manual
-operation of handheld valve by anesthesia
-low TV controlled manner
-simple and reliable
-higher airway pressures

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24
Q

How common is preeclampsia?

A

5% of all pregnancies

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25
Q

MOA of preeclampsia

A

-abnormal implantation of myometrial spiral arteries
-normally remodel to inc uterine BF
-in preeclampsia -> can’t remodel adequately -> high resistance in arterial flow -> stress response -> inc release of vascular mediators -> inc vascular resistance
-b/c uterine BF not autoregulated -> maternal systemic vasculature inc to compensate for optimal BF to uterus

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26
Q

What inflammatory cytokine especially involved in preeclampsia

A

Thromboxane
-inc vascular tone and plt aggregation

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27
Q

Why pulm edema or renal prob w/ preeclampsia?

A

High SVR -> dec renal BF
-pulm edema 2/2 capillary leakage

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28
Q

Preeclampsia dx

A

new-onset HTN after 20 weeks gestation w/ proteinuria OR w/ severe features
1. systolic >140 or diastolic >90 after 20 weeks or 2 occasions 4 hrs apart
AND
2. Proteinuria of 300 mg > 24 hrs or Protein:Cr of > 0.3
OR
thromboctopenia
inc cr
visual symp
AST/ALT inc
pulm edema

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29
Q

Preeclampsia w/ severe features

A
  1. systolic > 160 or diastolic > 110
  2. visual or cerebral symp (blurry vision, HA, AMS)
  3. thrombocytopenia < 100k
  4. Cr > 1.1 or greater than 2x baseline Cr
  5. AST and ALT >2x normal or RUQ pain (inflammation and stretching of liver capsule)
  6. pulm edema
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30
Q

Endothelial cells preeclampsia

A

abnormal and dysfunctional -> produce less nitric oxide and prostacyclin and more thromboxane -> profound vasoconstriction
**why pts at high risk or hx take ASA (dec thromboxane)

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31
Q

What med to take if high risk for PEC or hx of PEC?

A

ASA (dec thromboxane b/c COX inh) -> vasodilating

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32
Q

What meds to avoid in Myasthenia Gravis?

A

-CCB and Mg
-Aminoglycoside Abx (potentiate autoantibodies)
-Neostigmine (combined w/ home pyridostigmine makes it hard to quantify reversal) -> use sugammadex

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33
Q

RF for MG post op mechanical ventilation in thymectomy via median sternotomy

A
  1. Dx duration > 6 years
  2. Chronic respiratory illness
  3. Pyridostigmine dosage > 750 mg/day
  4. VC < 2.9 L

RF not specific to surgical approach:
1. EBL > 1L
2. Serum anti-ACh receptor titer > 100 nmol/mL
3. Pronounced dec response (18-20%) on low-freq repetitive n stimulation

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34
Q

RF for mechanical ventilation in MG in minimally invasive thymectomy approach

A
  1. Advanced stage of MG (bulbar involvement)
  2. BMI > 28
  3. Hx of prior myasthenic crisis
  4. Assoc w/ pulm resection

RF not specific to surgical approach:
1. EBL > 1L
2. Serum anti-ACh receptor titer > 100 nmol/mL
3. Pronounced dec response (18-20%) on low-freq repetitive n stimulation

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35
Q

How do volatile anesthetics inc CBF?

A

direct effect on vascular smooth m -> dec CVR causing vasodilation -> inc ICP

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36
Q

Effects of volatile anesthetics on CBF and CMR

A

CMR: dec in dose-dpt manner
-< 0.5 MAC red CBF
- > 1 MAC inc CBF due to attenutation of cerebral autoregulation -> vasodilation

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37
Q

Vasodilating potency of volatile anesthetics

A

halothane > enflurane > des = iso > sevo

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38
Q

Ketamine ICP, CBF, CMR

A

increase in all
***blunted if given w/ midaz, prop, volatiles

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39
Q

Which one is the inferolateral segment?

A

B
A: mid inferior segment
C: mid anterior segment
D: mid inferoseptal segment

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40
Q

When to use pulse wave doppler on a TEE?

A

measure BF velocities through pulm veins, mitral v, and in low flow areas of the heart

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41
Q

When to use a continuous wave doppler on TEE?

A

measure BF velocities through aorta, aortic valve, stenotic valve lesions, and regurgitant valvular jets

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42
Q

When to use color flow doppler on TEE?

A

enhance recognition of valvular abnormalities, aortic dissections and intracardiac shunts

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43
Q

RF for inc periop anxiety peds

A

-younger children (1-5)
-higher cognitive fxn w/ shy or withdrawn personalities
-children w/ anxious parents

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44
Q

How does a pt get shingles

A

Get VZV (usually chicken pox) -> dormant in dorsal ganglia -> immunocompromised -> reactivation

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45
Q

Which dermatomal distribution MC in acute herpes zoster?

A

MC:
1. thoracic spinal n
2. ophthalmic division of trigeminal n
3. maxillary division of trigmeinal n
4. cervical spinal roots
5. sacral spinal roots

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46
Q

succ and IOP

A

Increase for 10 minutes (likely due to extraocular m contraction)

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47
Q

What dec IOP?

A

Benzos
Barbs (Thiopental)
Inhaled anesthetic

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48
Q

RF for PDPH

A
  • young age (peak early 20s)
    -pregnancy
    -hx of HAs
    -smaler guage (larger bore) cutting needles
    -greater # of dural punctures
    -skill of operator
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49
Q

Quincke

A

Cutting needle

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50
Q

Whitacre

A

blunt needle

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51
Q

Early symptoms of ASA toxicity

A

tinnitus
N/V/D
vertigo
Resp alkalosis (hyperventilation) -> acts directly on resp center in medulla to inc resp drive

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52
Q

Late symp of ASA toxicity

A

-AMS
-hyperthermia
-noncardiogenic pulm edema
-AG metabolic acidosis

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53
Q

Why acidosis w/ ASA toxicity

A

inhibits citric acid cycle and causes uncoupling of oxidative phosphorylation

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54
Q

What type of hepatectomy does an adult undergo that is donating to a child?

A

L hepatectomy
(Segments II, III, and IV)
-technically easier to perform and requires less donor-liver volume

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55
Q

What type of hepatectomy does an adult undergo that is donating to an adult?

A

R hepatectomy
(segments V-VIII)
-more difficult procedure, larger volume of liver

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56
Q

When does PT return to normal in a donor hepatectomy?

A

POD 5

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57
Q

What is reported to the National Practitioner Databank?

A

-malpractice payments and settlements
-punitive action taken by peer-review organizations, professional societies, or accreditation organizations
-administrative actions that occur as a result of a professional review

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58
Q

When does EtCO2 conc reach max value w/ laproscopic surgeries?

A

40 minutes if ventilation constant

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59
Q

Why diagnostic lap trendelenberg pulse ox dec to 95% and EtCO2 inc to 40?

A

inc intraabd pressure -> dec diaphragmatic excusion -> restricting lung expansion -> V/Q mismatch -> pulm shunting

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60
Q

Capnothorax

A

CO2 diffusion into intrapleural space
-inc EtCO2 conc and inc mean airway pressure
**doesn’t need chest tube b/c CO2 rapidly absorbed once pneumoperitoneum released

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61
Q

Carboprost tromethamine MOA

A

analogue of prostaglandin-F2 alpha that promotes uterine contractions

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62
Q

SE of carboprost

A

N, V, bronchoconstriction
**avoid in asthma

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63
Q

Methylergonovine maleate MOA

A

ergot derivative -> uterine contraction

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64
Q

Methylergonovine SE

A

severe HTN from vascular smooth m constriction

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65
Q

Ritodrine MOA and use

A

selective beta 2 adrenergic agonist
-inhibits uterine contractions

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66
Q

1st line for neuropathic pain

A

TCAs, SNRIs, gapapentin, and pregabalin

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67
Q

MC type of neuropathic pain

A

diabetic neuropathy

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68
Q

Methadone MOA

A

NMDA antagonist
SSRI
opioid agonist

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69
Q

Tramadol MOA

A

mu opioid receptor agonist
weak SNRI

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70
Q

Carotid sinus

A

contains baroreceptors

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71
Q

Why hypoTN and bradycardia w/ carotid stenting

A

activation of carotid sinus baroreceptor -> glossopharyngeal n to medulla -> inhibits sympathetic neurons -> bradycardia, hypoTN

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72
Q

ppx for concern for bradycardia w/ carotid stenting

A

IV atropine or glyco
-transcutaneous pacing and transvenous pacing are also options

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73
Q

Why hypoTN and bradycardia w/ carotid endarterectomy

A

-have plaque near baroreceptor -> pressure wave detected by carotid sinus is dampened -> to compensate for dec signal, baroreceptors inc their sensitivity
-once plaque removed -> baroreceptors can be overstimulated by small changes in BP -> hypoTN and bradycardia

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74
Q

TURP syndrome symp

A

volume expansion prob (resp distress, pulm edema, CHF, HTN, bradycardia)
hypoNa (confusion)
specific irrigation solution

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75
Q

Post TURP Na is 120-130 and symp tx?

A

fluid restriction and loop diuretic

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76
Q

Post TURP Na < 120 and symp

A

hypertonic 3% saline and should be stopped once Na reaches 120

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77
Q

Complications of TURP solution distilled water

A

hemolysis, hemoglobinemia, hemoglobinuria, and hypoNa

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78
Q

Complications of TURP solution Glycine

A

hyperammonemia, hyperoxaluria, transient postop visual syndrome
Gly-SEEN -> issues w/ vision

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79
Q

Complications of TURP solution Mannitol

A

hyperglycemiia, lactic acidosis, osmotic diuresis

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80
Q

Complications of TURP solution Sorbitol

A

Osmotic diuresis and intravascular volume expansion

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81
Q

Toxicity of Cisplatin, carboplatin

A

acoustisc n damage, nephrotoxicity

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82
Q

Toxicity of Vincristine

A

peripheral neuropathy

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83
Q

Toxicity of Bleomycin

A

pulm fibrosis

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84
Q

toxicity of doxorubicin

A

cardiotoxicity: dilated cardiomyopathy

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85
Q

Toxicity of Trastuzumab

A

cardiotoxicity

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86
Q

Toxicity of cyclophosphamide

A

hemorrhagic cystitis
(prevent w/ Mesna antioxidant)

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87
Q

Toxicity of 5-FU, 6-MP

A

myelosuppression

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88
Q

What happens w/ accidental intrathecal injection of vincristine

A

ascending radiculomyeloencephalopathy -> almost always fatal

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89
Q

mixed venous for met-hg

A

increases b/c inc affinity for O2, dec unloading of O2 at tissue level and higher % of Hg saturated

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90
Q

tx for cyanide poisoning

A

goal: induce met-Hg, b/c cyanide will bind that readily
-Amyl nitrite and hydroxycobolamin

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91
Q

How long after SC injury does it itake to upregulate nicotinic ACh rec?

A

at least 24 hours, peak 7-10 days

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92
Q

When are ICU pts immbolized likely to inc ACh rec upreg?

A

greater than 16 days

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93
Q

How to reduce dilutional coagulopathy

A

FFP! and plts
-FFP for PT > 1.5x normal
-plts for plts < 75,000 in setting of clinically excessive bleeding
-fibrinogen should be kept greater than 100 w/ FFP or cryo
**plts last longer, FFP first

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94
Q

Lethal triad of trauma

A

hypothermia, acidosis, and coagulopathy
-warm the room!
-warm the fluids

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95
Q

Concerns for pts w/ achondroplasia

A

atlantoaxial instability
OSA
lumbar lordosis w/ leg bowing -> neuraxial can be difficult

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96
Q

dx of atlantoaxial instability

A

anterior atlantodental interval
> 2-3 mm abnormal= unstable
-usually widening will be seen w/ flexion

97
Q

Triggers for hypoK periodic paralysis

A

Stress
Cold/hypothermia
Carbohydrate load
Infection
Glucose infusion
metabolic alkalosis
alcohol
strenuous exercise
steroids
pregnancy

98
Q

Symp of hypoK periodic paralysis

A

weakness in limbs and trunk w/ diaphgram sparing
-2/4 TOF w/ airway patency and good O2 sat

99
Q

preferred IVF for hypoK periodic paralysis

A

Normal Saline
-high Cl causes mild acidosis -> preferred over alkalosis
**avoid glucose containing

100
Q

Epiglottis what to do?

A

OR -> Deep GA and intubate
-no muscle relaxants!
-use CPAP to maintain airway patency w/ inhalational GA
-ETT 1 size lower, have multiple sizes

101
Q

Goals to dec leakage through Bronchopulm fistula

A

short inspiratory time
low TV
low RR
low end exp pressure
goal to keep airway pressures below critical opening pressure of BPF
-lung isolation may help
-spontaneous ventilation&raquo_space; PPV

102
Q

Fast-tracking in ambulatory surgery

A

bypass phase 1 level of care in PACU
OR -> phase 2 level of care

103
Q

Aldrete score

A

Activity
Breathing
Circulation
Consciousness
O2 saturation
0 to 2 for all scores
9-10 needed to bypass phase 1 PACU care with no nscore < 1

104
Q

BIS reading for dexmedetomidine

A

BIS consistent w/ GA
low freq high amplitude EEG w/ BIS of 40-60

105
Q

GA levels BIS

A

40-60

106
Q

measured cardiac output if injectate is colder than programmed

A

underestimate cardiac output

107
Q

measured cardiac output if injectate volume is lower than programmed

A

overestimation

108
Q

When will you get underestimation of thermodilution CO

A
  1. injectate bolus volume is greater than programmed volume
  2. large volume of fluid given during reading
  3. injectate solution temp is colder than preprogrammed
  4. self-measuring Ti probe is warmer than actual injectate temp
109
Q

Overestimation of thermodilution CO

A
  1. injectate bolus volume is less than programmed volume
  2. injectate temp is warmer than preprogrammed temp
  3. self-measuring Ti probe is colder than injectate temp
110
Q

MC metabolic complication for pts after unclamping of pancreatic transplant

A

hypoglycemia

111
Q

Radiation equation

A

1/ radius ^2
-by doubling distance from source, radiation is 1/4th

112
Q

Closed Claims Project to improve pt safety and assist w/ registry studies
advantage?

A

Description of rare events

113
Q
A

Aortic Dissection

114
Q
A

Aortic Dissection TEE

115
Q

Allodynia

A

perception of an ordinary nonnoxcious stmulus as painful

116
Q

Anesthesia dolorosa

A

pain in area that lacks sensation (feared complication of neurolytic blocks for tx of trigeminal neuralgia)

117
Q

When doing spinal anesthesia for TURB what additional n has to be blocked?

A

Obturator

118
Q

Why additional block of obturator n w/ TURB?

A

esp w/ monopolar electrocatuery -> current can stimulate the obturator n as it passes ner inferolateral bladder wall -> sudden adduction of adductor m -> bladder rupture

119
Q

Why additional block of obturator n w/ TURB?

A

esp w/ monopolar electrocatuery -> current can stimulate the obturator n as it passes ner inferolateral bladder wall -> sudden adduction of adductor m -> bladder rupture

120
Q

Indications for hyperbarici O2 therapy

A

Air embolism, decompression sickness
-Poisoning: carbon monoxide, cyanide, HS, brown recluse spider bides
-Infxn: necrotizing infxn, refracotry chronic osteomyelitis, intracranial abscess, mucormysosis
-Acute ischemia: crush injury, compromised skin flaps, central retinal a/v occlusion
-Chronic ischemia: ischemic ulcers, radiationi necrosis
-Acute hypoxia: O2 support w/ lung lavage, blood loss anemia if transfusion delayed/unavailable
-Burns

121
Q

succ dosing in obese pts

A

increased dosing b/c inc pseudocholinesterase activity and inc extracellular fluid volume

122
Q

what is dosed on total body weight

A

maintenance infusion of propofol, succ

123
Q

What is dosed on lean body weight?

A

Thiopental
induction dose of propofol
fentanyl

124
Q

What is dosed on ideal body weight?

A

Roc, vec

125
Q

Why dec opioids in elderly?

A

Increased brain sensitivity
-doses should be cut in half compared to young and healthy pts

126
Q

Remi changes in elderly

A

Remi more potent in elderly brain b/c inc brain sensitivity, and central clearance decreased
-infusion rates dec by 1/3

127
Q

Morphine changes in elderly

A

Inc brain sensitivity and dec renal clearance

128
Q

Major anesthesia concern w/ cerebral palsy

A

inc GERD and esophageal dysmotility -> pulm aspiratory is increased and greater risk for postop pulm complicatios

129
Q

cerebral palsy and succinylcholine

A

no problem! no issues w/ hyperK
-muscles never fully developed or innervated so no inc in ACh receptors at NM jxn

130
Q

How to inc CO2 removal for VV-ECMO

A

inc flow of sweep gas through oxygenator (inc sweep)

131
Q

Where are cannulas for VV-ECMO?

A

internal jugular vein (down into SVC) or femoral vein (IVC)

132
Q

When to use VV ECMO?

A

profound refractory resp failure
-shunts blood from venous system, through oxygenator, and back to heart

133
Q

V-V ECMO

A
134
Q

What is the flow through VV ECMO?

A

Ideally pts cardiac output depending on size of cannulas and resistance

135
Q

Most effective way to treat intraop hypothermia of peds pt

A

forced warm air blanket

136
Q

Complications w/ intraop hypothermia

A

-dec wound healing (inc rate of infxn)
-inc O2 consumption -> metabolic acidosis
-delayed awakening
-inc PVR
-inc cardiac arrhythmias
-inc need for transfusion

137
Q

why peds pts highly likely to get hypothermia w/ anesthesia?

A

-anesthesia abolishes thermoregulatory reflexes
-bigger body surface area relative to total body volume -> inc heat loss
-less subq fat
-thinner skin

138
Q

Neonate nonshivering thermogenesis

A

metabolism of brown fat -> uncouples oxidate phosphorylation in mitochondria to get heat
(1st 3 months of life)

139
Q

Chronic pain meds that dec sz threshold

A

Tramadol
TCA (Amitriptyline)

140
Q

Butorphanol MOA

A

mixed opioid agonist-antagonist w/ partial agonism of mu and kappa opioid receptors
***if used w/ full agonist -> will be antagonist

141
Q

Meperidine and sz threshold

A

does NOT lower sz threshold
-sz b/c of buildup of metabolite normeperidine

142
Q

Early management of hemorrhagic shock

A

limited crystalloid admin (1L)and early intervention w/ balanced blood product administration

143
Q

“lethal triad” of trauma

A

hypothermia
acidosis
poor perfusion
-hypothermia and acidosis -> depletion of fibrinogen -> development of DIC

144
Q

MAP goals during early hemorrhagic shock 2/2 trauma

A

> 40 -> can be that low for 2 hours to prevent clot disruption and red blood loss
-limits fluid admin until hemostasis can be achieved

145
Q

Periop RF for a fbi

A

atrial injury
ischemia
inflammation
inc catecholamines
hypovolemia
atrial stretch from volume overload
electrolyte disturbances

146
Q

Patient factors inc risk of postop a fib

A

Advanced age
male
HTN
prior hx of A fib
obesity
COPD
asthma
valvular dx
left atrial size
LVEF

147
Q

Consequences of postop a fib

A

longer hospital stay
hemodynamic derangements
stroke
MI
development of vent arrhythmias
HF

148
Q

Greatest RF for development of postop a fib

A

Volume status -> hyper or hypovolemia

149
Q

ppx to prevent postop a fib

A

Beta blockers

150
Q

omphalocele, hypoglycemia, large body, large tongue, dx?

A

Beckwith-Wiedemann syndrome

151
Q

Beckwith-Wiedemann syndrome

A

congenital d/o caused by overgrowing of tissues
-omphalocele
-macroglossia (diff intubation)
-hypoglycemia (large pancreas)

152
Q

Down Syndrome MOA, assoc

A

trisomy 21
low muscle tone
cardiac defects (endocardial cushion defects)
large tongue
unstable atlantoaxial joint

153
Q

VATER

A

or VACTERL
vertebral
anal imperforate
TE:tracheoesophageal fistula
Renal abnormalities
Congenital cardiac condition
Limb abnormality

154
Q

Williams syndrome MOA, symp

A

deletion on chromosome 7
-“elf-like”
supravalvular aortic stenosis

155
Q

Risks of sedatio nand anesthesia in DMD and Becker MD

A

-inc risk of aspiration (resp m weakness, inc oral secretions, gastric hypomotility)
-upper airway obstruction
-hypoventilation
-atelectasis
-CHF
-dysrhythmias
-resp failure
-diff weaning from mechanical ventilation

156
Q

What gets reported to the National Practitioner Databank

A

Malpractice Payments and Settlements
Punitive action taken by peer-review org, professional societies or accreditation org
-administrative actions that occur as a result of a professional review

157
Q

1st action when taking someone out of a cold body of water?

A

Rescue breaths -> then CPR
-vomiting occurs frequently, consider airway protection

158
Q

Normal plasma levels of Mg

A

1.8-2.5

159
Q

Therapeutic goals of Mg for OB

A

5-10

160
Q

SE of Mg at 5-10

A

flushing
N/V
sedation
dizziness
m weakness
hypoTN, bradycardia
prolonged PR, wide QRS

161
Q

Mg level loss of DTR

A

12

162
Q

Complete heart block Mg level

A

18

163
Q

Cardiac arrest mg level

A

20-25

164
Q

Tx of hyperMg

A

IV calcium

165
Q

surge after ECT?

A

parasymp -> then symp

166
Q

SE of ECT

A

parasymp -> symp
HA
short term memory loss
nausea
myalgias

167
Q

PaO2 goal ARDS

A

60 or greater w/ adequate Hg at FiO2 of less than 50%

168
Q

ARDS dx

A

noncardiogenic pulm edema w/ hypoxemia

169
Q

ARDS TV

A

lower TV 6 cc/kg predicted body weight

170
Q

ARDS severity

A

partial pressure of arterial O2/FiO2
mild: P/F 200-300
mod: P/F 100-200
severe: P/F lower than 100

171
Q

laproscopic surgery and ICP

A

increase b/c dec cerebral drainage

172
Q

laparoscopic surgery and afterload

A

inc afterload, inc in SVR, inc in BP
-causes a dec in end organ perfusion (esp renal)

173
Q

pulm and laparoscopic surgery

A

-pulm compliance dec
-diaphragm moves cephalad -> dec TV and inc insp pressures
-inc atelectasis -> dec in FRC

174
Q

At what pressure w/ laparoscopic surgery do you start seeing compromised perfusion?

A

20

175
Q

MCC of death in pts w/ duchennes muscular dystrophy

A

CHF or aspiration PNA
-dysrhymias common b/c fibrosis in cardiac conduction system

176
Q

Induction for peds congenital emphysema

A

spontaneous respiration
-inhalational -> nitrous oxide CI
-likely lung isolation to prevent bleb burst
-have surgeon present in event of bleb rupture and PTX

177
Q

Best way to improve myocardial O2 supply and dec demand

A

dec HR
-less work, dec demand
-perfusion in diastole -> longer in diastole -> improved supply

178
Q

O2 content of blood

A

CaO2 = (Hg x 1.34 x SaO2) + (.003 x PaO2)

179
Q

Coronary perfusio npressure

A

CPP = Aortic DBP - LVEDP

180
Q

Cardiac wall tension

A

wall tension = (LVEDP x radius) / (2 x LV wall thickness)
-wall tension correlated to myocardial work

181
Q

Changes in lung volumes w/ pregnancy

A

TV inc
IRV inc
so IC inc

Dead space inc

FRC dec
ERV dec
RV dec

182
Q

Lung volumes and capacities

A
183
Q

Where does transcranial doppler u/s measure blood flow velocities?

A

MCA

184
Q

Why use transcranial doppler u/s w/ carotid endarterectomies?

A

measure flow velocities in MCA
-Mean flow velocity following clamping of the cartoid artery correlates w/ degree of cerebral ischemia
-if >40% of preclamped value, absent ischemia
-mild if 15-40% preclamped
-severe <15% preclamped

185
Q

Hyperperfusion syndrome CEA

A

> 100% inc in CBF relative to preop
-postop neuro dysfxn -> HA, sz, focal deficits, intracerebral hemorrhage, cerebral edema
***detect w/ transcranial doppler in early postop

186
Q

What is transcranial doppler used for?

A

Periop CEA
-BF velocities
-detect embolization to the brain
-identify shunt fxn of malfunction
-detect asymp carotid artery occlusion and/or hyperperfusion syndrome

187
Q

Adults 1st symp total spinal

A

cardiovascular signs 1st!
-hypoTN and tachycardia (brief reflex) and then progresses to bradycardia
-resp failure/LOC 2nd

188
Q

Neonates 1st symp total spinal

A

resp depression!
-supportive w/ intubation for controlled ventilation

if fails to oxygenate -> hypoxic cardiac arrest
-no sympathetic blockade b/c immature symp NS w/ predominant parasymp tone

189
Q

Unilateral nonradiating lower back pain exacerbation w/ rotation to affected side

A

facet syndrome

190
Q

What exacerbates facet syndrome

A

lumbar extension and rotation toward the affected side

191
Q

low back pain worse on 1 side, radiation to posterior buttock and thigh

A

sacroiliac joint dysfunction

192
Q

unilateral lower extremity numbness/weakness, worse w/ lumbar extension

A

spinal stenosis
-relieved w/ flexion

193
Q

sitting intolerance relieved by lateral recumbent position

A

discogenic disease
-exacerbated w/ sneezing, coughing, strainging

194
Q

Low back pain exacerbated w/ palpation of posterior superior iliac spine

A

sacroiliac joint dysfunction

195
Q

Why edema w/ sepsis?

A

Glycocalyx disruption

196
Q

Glycocalyx

A

mesh-like structure covering endothelial cells in blood vessels that:
-regulate vascular permeability
-maintain laminar blood flow
-prevent inappropriate activation of clotting cascade and immune response

197
Q

Changes in SSEPs that indicate ischemia

A

dec amplitude
inc latency

198
Q

small cell carcinoma of lung, new onset muscle weakness, improves w/ repetition

A

antibody to presynaptic calcium channel
-Lambert Eaton myasthenic syndrome

199
Q

Why is weakness improved w/ repeated repetition in lambert eaton

A

antibodies to presynaptic VG Ca channels at NMJ
-dec release of ACh -> weakness -> needs repetition to build up ACh

200
Q

Which myasthenia gravis or myasthenic syndrome more likely to affect bulbar muscles (mouth, throat), and eyes

A

myasthenia gravis

201
Q

Treatment for lambert ateon

A

Tx malignancy (likely small cell lung cancer)
-3,4-diaminopyridine (amifampridine) -> inc presynaptic release of ACh

202
Q

Lambert eaton and muscle relaxants

A

myasthenic syndrome: sensitive to both succ and roc
myasthenia gravis: resistant to succ, sensitive to roc

203
Q

stridor 24-96 hours post thyroidectomy

A

hypocalcemia (from destruction of parathyroid glands)

204
Q

stridor weeks after extubation

A

tracheomalacia
-acquired from inc pressure on the trachea from ETT

205
Q

What muscle does the superior laryngeal n innervate

A

cricothyroid muscle
-change in pitch of pt’s voice

206
Q

What happens to IV bicarb when given?

A

combines with hydrogen ion -> carbonic acid -> dissociates into CO2 and water

207
Q

What happens to CO2 when giving IV bicarb?

A

transient inc in EtCO2
-combines with hydrogen ion -> carbonic acid -> dissociates into CO2 and water
-theoretical inc in cerebral vasodil -> inc ICP

208
Q

What happens to calcium when giving IV bicarb?

A

bicarb -> alk -> H+ kicked off albumin -> uptake of Ca for neutrality -> hypoCa

209
Q

What happens to K when giving IV bicarb?

A

H+ low -> uptake of K+

210
Q

Caudal dosing for peds

A

-volume determines block height
-.5 cc/kg sacral
-1 cc/kg low thoracic dermatomes
-1.25 cc/kg cover mid-thoracic dermatomes

211
Q

when does dural sac end in newborns

A

S3

212
Q

conus medullaris in newborns

A

ends at L3

213
Q

adults dural sac ends at

A

S1-2

214
Q

Conus medullaris in adults

A

L1-2

215
Q

Extracellular fluid volume in infants

A

40% of total body weight

216
Q

Total body weight in infants

A

term: 75%
preterm 85%
-that’s why requires larger weight-based dosing of m relaxants

217
Q

extracellular fluid volume adults

A

20%

218
Q

total body waterin adults

A

60%

219
Q

when do peds reach adult extracellular fluid volume

A

18-24 months

220
Q

Why give larger doses of succ in peds

A

larger volume of distribution
(2-2.5 mg/kg)

221
Q

When is the NMJ mature in peds?

A

2 months
-prior to that, diaphgram and peripheral muscles paralyzed at the the same time

222
Q

Why dec in FRC w/ trendelenberg

A

FRC = ERV + RV
-red in lung compliance and cephalad shift

223
Q

initial compensatory mechanism for acute respiratory acidosis

A

plasma protein buffers
-Hg in RBC and phosphates -> CO2 reacts w/ H2O to form bicarb and H+ ions -> bicarb exchanged for Cl so bicarb in plasma
-kidneys do most of the work, but they need time

224
Q

How do kidneys react to resp acidosis?

A

inc excretion of Cl -> inc in bicarb reabsorption
-can take hours to days

225
Q

Adenosine MOA

A

transiently blocks the AV node

226
Q

Atrial tachycardia and adenosine

A

Regular SVT w/ ventricular rate b/c 150-250
-micreo-reetrant circuit or automatic atrial focus

227
Q

AV nodal reentrant tachycardia

A

reentrant pathway adjacent to or directly w/i AV node
-since involves AV node, adenosine will terminate

228
Q

AV reciprocating tachyardia

A

reentrant circuit including theAV node and an accessory pathway w/i cardiac musculature b/w atrium and ventricle
-will terminate w/ adenosine

229
Q

What rhythms will adenosine terminate?

A

SVTs caused by a reentrant circuit involving the AV node

230
Q

Adenosine and a fib

A

will slow ventriclar rate but will not terminate

231
Q

Adenosine and a flutter

A

will not terminate, just slow ventricular rate

232
Q

Why get burns w/ pulse ox probe in MRI

A

heat is generated w/ induction of electrical current w/i the probe

233
Q

Which metals are dangerous during MRI?

A

Ferromagnetic metals
-nickel, iron, cobalt

ALUMINUM IS SAFE

234
Q

Blood supply TEE

A
235
Q

Which papillary m most likely to rupture and why?

A

Posteromedial b/c single blood supply (PDA)

-anterolateral has dual blood suppl (LAD and LCx)

236
Q

What causes hoarseness following cervical spine surgery

A

vocal cord palsy
-result of direct pressure of the ETT on RLN during surgical retraction

237
Q

how to reduce hoarseness following cervical spine surgery

A

adjust ETT cuff pressure after surgical exposure most beneficial

238
Q

What happens w/ damaged RLN?

A

cricothyroid innervated by SLN -> unopposed -> VC adduction
-unilateral: dysphonia
-b/l: complete airway obstruction

239
Q

dysphonia/hoarseness w/ anterior cervical surgery prognosis

A

transient, spontaneous over weeks-months
-only 10% symp at 3 months
-if not better in 6 weeeks -> w/u

truelearn advanced exam (15 decks)

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