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BioScience II > article reviews- Josh > Flashcards

article reviews- Josh Flashcards

1
Q

ARF Postop:

what are 2 main prerenal faliure causes?

A

Diminished CO

Volume depletion

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2
Q

ARF Postop:

with prerenal cause of Diminished CO, what are some couses of the decreased Co

A
  • CHF
  • Cardiogenic shock
  • Acut MI
  • Dysrhythmia
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3
Q

ARF Postop:

with prerenal causes what causes volume depletion

A
  • hemorrhage
  • Spsis
  • GI blood/fluid loss
  • Hypoalbuminemia
  • 3rd spacing
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4
Q

ARF Postop:

what are 3 postrenal causes

A

ureteral obstruction

Bladder neck obstruction

Vascular obstruction

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5
Q

ARF Postop

w/ post renal failure, what causes the ureteral obstruction?>

A
  • surgical ligation
  • Papillary necrosis
  • calculi
  • Blood clot
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6
Q

ARF Postop:

w/ post renal failure what are some causes of Bladder neck obstruction?

A

prostate enlargement

Bladddr calculi

Urethral stricture

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7
Q

ARF Postop:

w/ post renal failure what are some causes of vascular obstruction

A
  • Renal vein thrombosis
  • Surgical ligation
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8
Q

ARF Postop:

what are 3 causes of intrarenal failure?

A

tubular damage

Interstitium damage

Vascular damage

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9
Q

ARF Postop:

w/ intrarenal failure what causes tubular damage?

A
  • ATN
  • Endogenous toxins
  • Exogenous toxins
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10
Q

ARF Postop:

w/ intrarenal failure what causes interstitium failure?

A
  • Drugs (abx, NSAIDS)
  • Infections
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11
Q

ARF Postop:

w/ intrarenal faliure what causes Vascular failure?

A

drugs

thrombotic states

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12
Q

initially hypercalemia causes hyperexcitability of cellular membranes how?

A

by moving the resting membrane potential closer to the threshold potential, thus a smaller stimulus is needed to initiate a contraction

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13
Q

initially hypercalemia causes hyperexcitability of cellular membranes by moving the resting membrane potential closer to the threshold potential, thus a smaller stimulus is needed to initiate a contraction eventually the Na-K ATPase pump begins to fatigue from excessive depolarizations, and the cellular membrane becomes what?

A

less excitable

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14
Q

what does hyperkalemia due to NMB induced by muscle relaxants

A

it potentiates the NM blockade by decreasing the excitability of the skeletal muscle

remember (
initially hypercalemia causes hyperexcitability of cellular membranes by moving the resting membrane potential closer to the threshold potential, thus a smaller stimulus is needed to initiate a contraction eventually the Na-K ATPase pump begins to fatigue from excessive depolarizations, and the cellular membrane becomes less excitable)

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15
Q

what are major presentations of residual NM blockade?

A
  • airway obstruction
  • hypoventilation
  • hypoxemia
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16
Q

Hyperkalemia can contribult to residual what? (r/t MR)

A

muscle weakness

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17
Q

Hemostasis:

how is a platelet plug made?

A
  • plts activated at site of injury to form a platelet plug that provides the initial hemostatic response
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18
Q

Hemostasis:

what the primary events of Clot formation

A
  • exposure to tissue factor (III) at the site abd it’s interaction w/ Factor VII and the Factor X (hagman factor)
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19
Q

Hemostasis:

what are the primary events for termination of clot

A
  • involves factor antithrombin, tissue factor pathway inhibtor, and protein C pathway
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20
Q

Hemostasis:

whay is there clot lysis?

A

restore vessel patency

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21
Q

Hemostasis:

steps for clot lysis

A
  • plasminogen binds fibrin to tpa
  • activate proteolytic plasmin
  • cleaves fibrin, fibrinogen, and a variety of plasma proteins and clotting factors
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22
Q

what is the impairment of hemostasis and activation of fibrinolysis that occurs d/t severe injury

A

Acute traumatic coagulopathy (ATC)

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23
Q

ATC:

what are standard test?

A
  • PT/INR
  • aPTT
  • finrinogen level
  • plt count
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24
Q

ATC:

pt’s w/o preexisting coag defects that have a prolonged PT and/ot PTT > _____ x’s normal have ATC

A

> 1.5x’s normal

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25
Q

ATC:

what type of coag monitoring is useful for monitoring ongoing resuscitation in injured pts

A

Thomboelastography

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26
Q

what test measure the VISOELASTIC properties of clot formation providing information on clot initiation, clot strength, and fibrinoysis

A

TEG

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27
Q

ATC:

what is plasma based resuscitation for a pt dx w/ ATC

A

PRBCs

FFP

PLT

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28
Q

ATC:

what are 3 hemostatic agents for severe coagulopathy?

A

Factor VIIa

Prothrombin complex concentrate

antifibrinolytic agents

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29
Q

what is a metalloprotease that cleaves vWF within developing platelet-rich thrombi to prevent hemolysis, thrombocytopenia, and tissue infarction

A

ADAMTS13

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30
Q

Most adult cases of ITTP are d/t acquired antibodes that inhibit what?

A

ADAMTS13

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31
Q

ITTP:

805 of pt’s respond to what treatment?

A

plasma exchange

(removes antibody and replinishes ADAMS13)

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32
Q

ITTP:

Immunosupression w/ what drug may be as effective as salvage therapy

A

rituximab

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33
Q

what is teh most frequent complications that require admission r/t Sickle Cell Disease (SCD)

A

acute bone problems

painful vaso-occlusive crises and osteomyelitis

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34
Q

Bone Involement in SCD:

what complication startes in late infancy and continues throughout life

A

Vaso-occlusive crises

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35
Q

Bone Involement in SCD:

what is a complex pathogenisis that involves the activation and adhesion of Leukocytes, plts, endotheliel cells, and HgbS, can occur in any organ but most common in bone marrow?

A

microvascular occlusion

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36
Q

Bone Involement in SCD:

Osteolyelitis is thoought o be caused by what?

A

Hyposplenism

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37
Q

Bone Involement in SCD:

what bacteria is most commonly the cause of osteomyelitis list fom most to least common

A

Salmonella

staph A

Gram neg enteric bacilli

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38
Q

Bone Involement in SCD:

what is the most disabling chronic bone d/o

A

osteonecrosis

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39
Q

GERD and It’s effect in DL and Intubation:

changes at the cellular level can produce ____ and subglottic ______ making the airway difficult

A

edema

stenosis

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40
Q

GERD and It’s effect in DL and Intubation:

Hx of what should alert you to ptential abnormalities from GERD and erosion of laryngotracheal mucosa

A

Chronic cough

hoarseness

throat clearing

dysphagia

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41
Q

GERD and It’s effect in DL and Intubation:

if GERD causes occult aspiration it can mimic what other diseases

A

Asthma

Bronchitis

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42
Q

GERD and It’s effect in DL and Intubation:

subglottic edema seen w/ GERD can be dramatically decreased w/

A

preop meds

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43
Q

GERD and It’s effect in DL and Intubation:

what ttype of drugs are cimetidine, Famotidine, nizatidine, rantididine?

A

H2 antagonist

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44
Q

GERD and It’s effect in DL and Intubation:

what type of drugs are alka-selzwer, di-gel, gavison, maalox, mylanta, riopan plus, rolaids, tums

A

antacids

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45
Q

GERD and It’s effect in DL and Intubation:

what type of drugs are cisapride, Metoclopramide?

A

Gastrokinetics

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46
Q

GERD and It’s effect in DL and Intubation:

what type of drug is omeprazole

A

PPIs

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47
Q

GERD and It’s effect in DL and Intubation:

combos of the previous drugs should be started at least ___ hours before anticipated GA

A

72

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48
Q

Genetic Nutrition: Nutritional issues in older adults:

the involuntary loss of > 5-10% of older adults usual weight during 1 year = what

A

increased risk for mortality

49
Q

Genetic Nutrition: Nutritional issues in older adults:

involutary weight loss is generally r/t 1 or a combo of what 4 conditions

A
  1. inadquate dietary intake
  2. Appetite loss (anorexia)
  3. Muscle atrophy
  4. Imflammatory effects of disease
50
Q

Genetic Nutrition: Nutritional issues in older adults:

inadequate dietary intake can be r/t what issues

A

social

psychospcial

medical

physiological

51
Q

Genetic Nutrition: Nutritional issues in older adults:

what isi teh most prevelent condition that causes weight loss in the older adult

A

depression

52
Q

Genetic Nutrition: Nutritional issues in older adults:

what is te 2nd most common cause of weight loss

A

Cancer

53
Q

Genetic Nutrition: Nutritional issues in older adults:

sarcopenia (a degenerative loss of muscle mass) is often r/t what?

A

testosterone and estroge reductions

increase in insulin resistance

54
Q

Genetic Nutrition: Nutritional issues in older adults:

if a DM pt is having issues with weight, do you place them on a diabetic diet still

A

fuck no, just monitor them closer

55
Q

Genetic Nutrition: Nutritional issues in older adults:

should you treat w/ appetite stimulamnts such as megestrol and dronabinol?

A

nope they show no benefits

56
Q

Genetic Nutrition: Nutritional issues in older adults:t

15% of ppl > 60 have what vit def

A

B12

57
Q

Electrolyte changes…..TURP:

the study recomend checking what levels in prop for TURP pt’s

A

K+

Na+

Ca++

58
Q

Electrolyte changes…..TURP:

why o you want to optimize their electrolytes b4 sx

A

to prevent serious and fatal complications

59
Q

Electrolyte changes…..TURP:

normally there is a fall of what in Na+ during a TURP?

A

5-8mEq/L

60
Q

Electrolyte changes…..TURP:

procedure lasting longer than _____ min and volume of prostate gland greater than ____ could be associated w/ more complication

A

think 60

60 min

60 ml

61
Q

Electrolyte changes…..TURP:

limit height of irrigation fluid column to ____cm can provide optimal vision to surgeon and reduce complications of fluid absorption

A

60 cm
(23-24 inch)

i think bill stated a lower height of 16-18 inches

62
Q

Electrolyte changes…..TURP:

what is a widely used irrigant, b/c of it’s good optical properties, and non-electrolytic properties that prevent dissipation of diathermy current durrent resection

A

Glycine 1.5%

63
Q

Electrolyte changes…..TURP:

is glycine 1.5 % hypo/hyper/or isotonic

A

slightly Hypotonic

64
Q

Electrolyte changes…..TURP:

early identification of TURP syndrome and it’s treatment should be based on administration of what?

A

hypertonic saline

65
Q

Electrolyte changes…..TURP:

S/S of TURP syndrome CNS

A

restlessness

H/A

Confusion

Convulsions

Coma

Visual disturbances

N/V

66
Q

Electrolyte changes…..TURP:

S/S TURP syndrome CV and respiratory

A
  • HTN
  • Tachycardia
  • Tachypnea
  • Hypoxia
  • Pulm edema
  • Hypotension
  • bradycardia
67
Q

Electrolyte changes…..TURP:

S/S of TURP syndrome metabolic and renal

A

Hyponatremis

Hyperglycemia

IV hemolysis

Acute renal failure

68
Q

Perioperative management of pt w/ liver dz:

the conerstone of periop maagement are medical treatment of liver disease complications such as what?

A
  • Coagulapathy
  • Ascites
  • Encephalopathy
  • Malnutrition
69
Q

Perioperative management of pt w/ liver dz:

what do you want to pay close attention to post op

A

risk factors for infection

70
Q

Perioperative management of pt w/ liver dz:

Sepsis, coagulopathy, and emergency sx are most strogly associated w/ what?

A

post op mortality

71
Q

Perioperative management of pt w/ liver dz:

what are risk stratification systems?

A

CTP score

MELD score

ASA

72
Q

Perioperative management of pt w/ liver dz:

Surgery is contraindicated if what CTP class

A

C

73
Q

Perioperative management of pt w/ liver dz:

why should you use sedatives and MR w/ caution

A

prolonged duration of action

74
Q

Perioperative management of pt w/ liver dz:

how do you want to optimize Cirrhosis pt’s

A
  • correct coag (PTT w/in 3 sec of NL)
  • Goal Plt count > 50-100,000
  • Minimize ascites
  • Address nutritional status
75
Q

Perioperative management of pt w/ liver dz:

what narc is prefered

A

fenatanyl

76
Q

Perioperative management of pt w/ liver dz:

how do you treat coagulopathy

A
  • Vit K
  • FFP if Vit K ineffective
  • Cryoprecipitate
  • DDAVP if bleeding time prolonged
  • goal PT w/oin 3 sec NL
77
Q

Perioperative management of pt w/ liver dz:

how to treat encephalopathy

A
  • Lactulose
78
Q

Perioperative management of pt w/ liver dz:h

ow to treat ascites

A

Diuretics

Fluid restriction

large volume paracentesis

79
Q

Diagnosing HIT in Cardiac surgical pts…:

Cardiac sugical pts are at increased risk for post op HIT d/t what factors

A

High dose heparin

platelet activation

CPB

80
Q

Diagnosing HIT in Cardiac surgical pts…:h

How does HIT occur?

A

immune mediated response

  • teh anticoagulant causes a procoagulant effect via platelet activating antibodies that reconize multimeric platelet factoe 4 (PF4) heaprin complexes on platelet surfaces
81
Q

Diagnosing HIT in Cardiac surgical pts…:

what are CV pt’s so hard to diagnose?

A

b/c they have thrombocytopenia for frst 72 hours post op anyways

82
Q

Diagnosing HIT in Cardiac surgical pts…:

prompt reconition is crucial b/c cessation of haparin and treatment w/ what reduces the risk of thromboembolic events

A

direct thrombin inhibitor

83
Q

Diagnosing HIT in Cardiac surgical pts…:

what are 2 types of assays to detect HIT

A

Functional assays

enzyme imunoassays

84
Q

Diagnosing HIT in Cardiac surgical pts…:

whaich assay has the highest sensitivity and specificity?

A

Functional assay

85
Q

Diagnosing HIT in Cardiac surgical pts…:

why is the functional assays not used ofter?

A

impractical due to being very time intensive and lack of avilability

86
Q

Diagnosing HIT in Cardiac surgical pts…:

what are 2 ex of funtional essays

A

HIPA (Heparin induced platelet activation assay)

SRA (serotonin release assays)

87
Q

Diagnosing HIT in Cardiac surgical pts…:

so the enzyme immunoassays (EIA) also have a high sensitivity and rapid result but what is bad about them?

A

a high number of false positives

88
Q

Airway management w/ ALL:

ALL is the most comon malignancy in who

A

children

89
Q

Airway management w/ ALL:

pulmonary comlications

A
  • PNA’oulm leukostasis
  • malignant pleural effusion
  • upper airway obstrction
90
Q

Airway management w/ ALL:

what isteh malignancy of blast cells d/t failure of cell maturation leads to accumulation of useless cells at the expense of normal hemopoietic cells

A

Acute leukemia

91
Q

Airway management w/ ALL:

S/S

A

fatique

bone/joint pain

fever w/o infection

weightloss

abnormal masses

splenomegaly

leymphadenopathy

hepatomegaly

sternal tenderness

anterior mediastinal masses

petechiae/purpura

mucus membrane bleeding

fundal hemarrhage

CNS involbement

ARF

92
Q

Airway management w/ ALL:

diagnosis of ALL is made how

A

demostration of 20% lymphoblasts in teh bone marrow

93
Q

Airway management w/ ALL:

in kids why is there a difficult airway?

A

> compression of upper airway and inability of narrower lumen to accomadate edema =airway obstruction

94
Q

Airway management w/ ALL:

what med has been used w/o abx in oropharyngeal obstruction

A

Dexmethasone

95
Q

Society for ambulatory ……. Management of PONV:

can antiemetic prophylaxis eliminate PONV

A

nope but it can reduce it

96
Q

Society for ambulatory ……. Management of PONV:

sorry McD but 5-HT3 receptor antagonist are more effective in prophylaxis when given when

A

at end of sx

97
Q

Society for ambulatory ……. Management of PONV:

decadron is recomended at a dose of ___ at the induction to decrease PONV

A

4 mg

98
Q

Society for ambulatory ……. Management of PONV:

adults at a _____ risk for PONV should receive combination therapy w/ oone or more prophylactc drugs from different classes

A

moderate

99
Q

Society for ambulatory ……. Management of PONV:

when a rescue therapy is needed what type of antiemetic should be given

A

one from a defiierent class than used for prophylaxis

100
Q

Society for ambulatory ……. Management of PONV:

if PONV occurs w/in ___ hours postop pts should not receive a repeat dose of prophylactic antiemetic

A

6 hours

101
Q

Society for ambulatory ……. Management of PONV:

if it has been more the ____ hours an emetic episode can be treated w/ any of the g=drugs used for prophylaxis except decadron and scopolamine

A

6

102
Q

Society for ambulatory ……. Management of PONV:wh

at are the pt specific risk factors

A
  • female
  • Nonsmoker
  • hx of PONV
  • Motion sickness
103
Q

Society for ambulatory ……. Management of PONV:

what are anesthestic risk factors

A

VAAS

N2O

intrap/postop opioids

104
Q

Society for ambulatory ……. Management of PONV:

what are surgical risk factors

A
  • Duration of sx (each 30 min increases risk by 60 %)
  • type of sx (lap, laparotomy, breast, stribismus, plastic sx, maxillofacial, gyn, abd, neuro, opthalmic, and uro)
105
Q

Anticancer…anesthesia implications:

Chemo agents can cause ____ and _____ complications in the lungs

A

pneumontis and

Pulmonary fibrosis

106
Q

Anticancer…anesthesia implications:

what is a red flag for the development of pneumonitis and pulm fibrosis

A

dyspnea at rest

107
Q

Anticancer…anesthesia implications:

pt’s eho had bleomycin should not receive ____ inspired O2 and _____ (a type of fluids) should be used during and after sx

A

high

Colloids

108
Q

Anticancer…anesthesia implications:

____toxicity occurs w/ most anticancer drugs

A

hepatotoxicity

109
Q

Anticancer…anesthesia implications:

what drug class can reduce the excretion of methotrexate

A

NSAIDs

110
Q

Anticancer…anesthesia implications:

________ causes central and autonomic nervous sytem toxicity and peripheral neuropathies thus regional anesthesia is contraindicated

A

Vincristine

111
Q

Renal:

the thick ascending loop gets close to the glomerulus (cortex) and cuddles next to the afferent arteriole. thsi part of the loop is called the what?

A

MACULA DENSA

112
Q

Renal:

the macula densa has specialized cells and the arteriole has specialized cells and together these celles are called the what

A

juxtaglomerular apparatus

113
Q

Renal:

the juxtaglomerular apparatus has an important role in the excretion of what?

A

renin

114
Q

Renal:

renin secretion is stimulated by what 2 things

A
  1. renal hypoperfusion
  2. SNS stimulation
115
Q

Renal:

what are the 2 major systemic effects of ATII

A
  1. systemic vasoconstriction
    • by enhancing NE release
  2. Na+ and H20 retention
116
Q

Renal:

aldosterone is released from where?

A

the adrenal cortex

particulary the zona glomerulose

117
Q

Renal:

in the collecting tubules there is 2 type of cells?

A
  1. principle cells
    • reabsorb Na+, Cl-, and secrete K+
  2. Intercalated Cells
    • secrete H+ or HCO3 and reabsrb K+
118
Q

that is I am done there is more but I am done with flash cards for this test I am whooped

A

shoot me in the head

BioScience II (39 decks)

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