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Truelearn Advanced Exam > TL block 5 > Flashcards

TL block 5 Flashcards

1
Q

RF for children undergoing T&A OSA in PACU

A

hx of prematurity
age < 3
neuromuscular d/o
URI w/i 4 weeks of surgery
nasal or craniofacial d/o

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2
Q

Anesthetic goals for HOCM

A

-maintain sinus rhythm
-reduce sympathetic stimulation
-maintain LV filling (preload)
-maintain SVR

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3
Q

Factors that promote LVOT obstruction in hypertrophic cardiomyopathy

A

tachycardia
hypovolemia
vasodilation
high chronotropic/inotropic state

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4
Q

Complications of using glycine for TURP

A

AMS (ammonia)
transient blindness
hyperoxaluria

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5
Q

Complications of mannitol for TURP

A

hyperglycemia
lactic acidosis
osmotic diuresis

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6
Q

Complications of sorbitol for TURP

A

osmotic diuresis

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7
Q

Use of labetalol in pheochromocytoma surgery

A

AVOID
-if not adequately alpha blocked, the circulating calecholamines will have unopposed alpha stimulation -> makes HTN worse
-b/c long-acting will get hypoTN once pheo removed

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8
Q

What anti-HTN should be used during pheo?

A

Direct acting vasodilators: nicardipine, nitroprusside, NG
phentolamine (alpha blockers)

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9
Q

Esmolol for pheo

A

can only be used conservatively if preop alpha-antagonism has been completed

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10
Q

alpha-methyl-para-tyrosine

A

inhibits tyrosine hydroxylase (rate limiting step in catecholamine synthesis)
-adjunct in malignant or inoperable tumors

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11
Q

MOA botulinum toxin

A

-cleaves SNARE protein -> stops fusion and release of ACh into nerve terminal -> flaccid paralysis

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12
Q

MOA tetanus toxin

A

travels retrograde up motor neron -> prevents release of GABA from interneurons
**inhibitory mechanism inhibited -> spastic paralysis

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13
Q

What color glasses to protect from neodymium:yttrium aluminumm garnet laser?

A

green
Nd:YAG =green

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14
Q

What color glasses to protect from CO2 laser

A

clear

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15
Q

What color glasses to protect from argon?

A

orange
arangatang = orange

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16
Q

What color glasses to protect from potassium-titanyl-phosphate-Nd:YAG

A

orange-red
lots of names require 2 colors

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17
Q

Aortic cross clamp hemodynamic changes

A

-inc BP above the clamp
-dec BP below clamp
-segmental wall motion abnormalities
-inc LV wall tension
-dec EF
-dec cardiac output
-dec renal blood flow
-inc pulm occlusion pressure
-inc CVP
-inc coronary blood flow

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18
Q

Aortic cross-clamp metabolic changes

A

-dec total body O2 consumption
-dec total body CO2 production
-inc mixed venous
-dec total body O2 extreaction
-inc epi and norepi
-resp alkalosis
-metabolic acidosis

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19
Q

coronary blood flow aortic cross clamp

A

increased BF b/c inc aortic diastolic pressure

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20
Q

hypoxia w/ one-lung ventilation for bronchopulm lavage steps

A

-ensure DLT in correct position
-fiO2 1
-PEEP to ventilated lung
-suctioning and bronchodilators

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21
Q

RF for uterine rupture

A

polyhydramnios
uterine scar (prior surgery)
adv maternal age

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22
Q

Which part of maternal risk is decreased w/ elective c/s versus vaginal delivery

A

uterine rupture (less b/c no contractions)

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23
Q

higher risk for hysterectomy: vaginal or c/s?

A

c/s
-b/c if bleeding uncontrolled during c/s hysterectomy

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24
Q

Increase in maternal blood volume w/ pregnancy

A

45% inc
(mediated by Na retention from renin-angiotensin system)

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25
Q

Normal P50 for Hg

A

27
-PaO2 at which 50% of molecules bound by O2

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26
Q

P50 for maternal Hg

A

30
-PaO2 at which 50% of molecules bound by O2
(R shift of curve)

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27
Q

P50 for fetal Hg

A

19-21
–PaO2 at which 50% of molecules bound by O2
(left shift of curve)

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28
Q

How does maternal blood volume inc in pregnancy

A

sodium retention via renin-angiotensin system -> dilutional anemia

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29
Q

Normal Hg in pregancy

A

> 11
-dilutional anemia (why Hg curve shifts to the R)

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30
Q

How is pregnancy hypercoagulable

A

inc in fibrinogen and factor VII

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31
Q

Tx no pulse

A

defibrillation
torsades! give IM Mg as well

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32
Q

dec in fetal HR after peak of uterine contraction prob?

A

late decel
utereoplacental insuff -> fetal lhypoxia

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33
Q

abrupt dec in fetal heart rate not assoc w/ uterine contractions

A

variable decelerations
-cord compression

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34
Q

gradual dec in fetal heart rate correlate w/ uterine contractions

A

early decel
fetal head compression

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35
Q

Types of decel in fetal HR and causes

A

VEAL CHOP
Variable: cord compression
Early: head compression
Accelerations: OK
Late: placental insuff

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36
Q

Treatment of hyperammonia by glycine in TURP

A

Arginine
-promotes urea formation from ammonia and excretion

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37
Q

What solution causes dispersion in TURP?

A

normal saline and other balanced salt solutions b/c of ionic composition

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38
Q

best method of pain control for thoracotomy

A

thoracic epidurals and paravertebral blocks

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39
Q

Difference between coma and persistent vegetative state

A

persistent vegetative state = cerebral death
-both unable to follow commands, communicate or have purposeful movements
-PVS can get spontaneous eye opening, possible sleep wake cycles, possible vocalizations not purposeful
-PVS home care can be possible, coma requires hospital

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40
Q

RF for pulm artery rupture w/ pulm artery catheters

A

hypothermia (stiff catheter)
anticoagulation
old age
pulm HTN

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41
Q

MC complication of PAC insertion

A

RBBB
-can still get LBBB and CHB, R most common

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42
Q

endocarditis and pulm artery catheter

A

2x increase if non-heparin coated catheters used

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43
Q

What 2 metals are MRI safe?

A

aluminum and brass

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44
Q

axillary n block

A
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45
Q

axillary n block surrounding musculature

A
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46
Q

planes for u/s brachial plexus blocks

A
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47
Q

What innervates the medial forearm?

A

antebrachial cutaneous nerve
-blocked w/ axillary n block w/i axillary fossa

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48
Q

genetic dx w/ subglottic stenosis

A

Trisomy 21 (Down Syndrome)

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49
Q

Down Syndrome airway concerns

A

subglottic stenosis
atlantoaxial joint instability
macroglossia
floppy soft palate
enlarged tonsils and adenoids

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50
Q

DM and airway

A

type 1 chronic hyperglycemia -> glycosylation of joints and affects atlanto occipital joint and compromises neck extension

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51
Q

pathologic cervical spine fusion assoc?

A

ankylosing spondylitis

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52
Q

why swelling w/ hypothyroidism

A

inappropriate ADH secretion

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53
Q

Alveolar gas equation

A

PAO2 = FiO2* (Patm-PH2O) - (PaCO2/resp quotient)

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54
Q

Arterial O2 content equation

A

CaO2 = (SaO2Hg1.36) + (PaO2*0.003)

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55
Q

Body resp to hypoxia at higher altitude

A

-inc minute ventilation
-cardiac output inc
-inc in EPO from kidneys to inc RBCs -> inc viscosity inc risk of thrombosis
-inc pulm hypoxic vasoconstriction -> inc strain on R heart

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56
Q

ICU pt inc pulm insp pressures and hypoxia causes:

A

-ventilator assoc lung injury
-vent induced lung injury
-Auto PEEP
-alveolar rupture -> PTX (barotrauma)

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57
Q

ppx for peds to prevent apneic episodes prior to surgery

A

caffeine
aminophylline

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58
Q

If infant has no hx of bradycardia or apnea, how long to proceed w/ elective outpt procedure

A

44-60 weeks post conceptual age

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59
Q

If pt is less than 44-60 postconceptual age, and req general anesthesia postop plan?

A

postop in hospital monitoring 12-24 hours

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60
Q

RF for postop apnea in peds

A

general anesthesia
IV sedation
anemia
-proportional to gestational age and postconceptual age

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61
Q

if infant has hx of apnea and bradycardia, when should they get elective surgery?

A

six months after free from any apnea or bradycardia episodes

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62
Q

Difference b/w CRPS I and II

A

CPRS I: occurs in absence of prior n injury
CRPS II: occurs after n injury

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63
Q

hyperalgesia, allodynia, abnormal sweating, color change sin extremity, dx?

A

CRPS

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64
Q

allodynia

A

pain caused by stimulus that does not normally elicit pain

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65
Q

Def of URI w/ severe symtpoms and case should be delayed

A

fever
purulent d/c
lethargy
changes in behavior
abnormal lung exam

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66
Q

breathing alterations in bronchpulm dysplasia

A

inc airway resistance
inc physiologic dead space
inc work of breathing
-> wheezing, intercostal restractions, nasal flaring, hypoxia, hypercarbia

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67
Q

Def of bronchopulm dysplasi

A

requirement for supplemental O2 at 28 days in infants born before 32 weeks
**chronic

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68
Q

RF for bronchopulm dysplasia

A

-prematurity
-PDA
-prenatal and postnatal infxn
-O2 toxicity
-mechanical venilation
-excessive IV fuilds

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69
Q

Pathology of bronchopulm dysplasia

A

-interstitial fibrosis, alveolar hypoplasia, dec septation

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70
Q

treatment of bronchopulm dysplasia

A

-CPAP or mechanical vent (low TV and O2)
-adequate nutrition
-fluid restriction 120-150 cc/kg/day
-steroids (improve lung fxn and dec inflammation)
-diuretics
-bronchodilators

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71
Q

Triad of congenital diaphragmatic hernias

A

dyspnea
cyanosis
dextrocardia

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72
Q

assoc dx w/ congenital diaphragmatic hernia

A

congenital heart dx
intestinal malrotations
-more likely in females

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73
Q

Anesthetic goals in congenital diaphragmatic hernias

A

-permissive hypercapnia (avoid large TV or peak pressures in lungs)
-maintain temperature
-limit PVR
-avoid nitrous oxide
-NO venous access in lower extremities -> when abd contents returned may compress IVC

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74
Q

Why is inhalational induction faster in infants

A

-larger proportion of blood going to vessel rich group
-dec solubility of sevo in blood (more water, less proteins)

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75
Q

Neonatal resuscitation

A

if poor tone: dry, stimulate, clear oral secretions
-if still apneic/gasping, HR < 100 -> position clear airway, PPV -> HR still < 100 -> ETT
-if HR < 60: intubate, chest compressions -> still no improvement give epi in umbilical vein catheter

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76
Q

Pierre Robin Sequence symp

A

airway obstruction
glossoptosis (tongue further back than it should be)
micrognathia
**assoc w/ dec esophageal motility-> get swallow study first! high risk of aspiration
-50% cleft lip/palate

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77
Q

treatment for neonates w/ euvolemic hypoTN

A

Atropine!!
-immature symp nervous system, predominate parasymp NS
-dec catecholamine stores and insensitive to exogenous catecholamines
-b/c of dec lithotripsy (can’t relax, why cardiac output is dept on HR! fluids don’t make a difference if euvolemic

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78
Q

Why do infants have a faster inhalational induction w/ sevo compared to adults?

A

-increased MV relative to FRC
-dec blood and tissue solubility of sevo
-inc proportion of cardiac output goingn to vessel-rich group

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79
Q

if pt having a tracheoesophageal fistula repaired, what should be evaluated?

A

echo! cardiac structural abnormalities
-not usually cardiac conduction dx, structural!
VACTERL
Verebral, Anal imperforate, TE fistula, Renal, Limb abnormalities

80
Q

if pt had tracheoesophageal repair, and looking to do caudal anesthesia for imperforate anus repair, what should be done first?

A

lumbosacral spine imaging to r/o neural tube defect (CI to caudal anesthesia)
VACTERL
Verebral, Anal imperforate, TE fistula, Renal, Limb abnormalities

81
Q

Goal SpO2 in congenital diaphragmatic surgery

A

90-95%

82
Q

Anesthestic goals for congenital diaphragmatic hernia

A

-permissive hypercapnia (PaCO2 up to 65)
-maintain normothermia
-SpO2 90-95%
-prevent worsening pulm HTN

83
Q

if congenital diaphragmatic hernia surgery and pt gets hypoTN and hypoxia whats going on?

A
  1. PTX -> chest tube, needle decompression
  2. worsening pulm HTN -> start inh NO
84
Q

What to avoid in pt’s w/ methylenetetrahydrofolate reductase def

A

Nitrous oxide -> inhibits methionine synthetase -> elevation in homocysteine, inc risk of thrombosis and acute coronary events

85
Q

What pt population is propofol typically avoided?

A

Mitochondrial d/o
-direct mitochondrial resp chain inhibition -> cause of propfol-related infusion syndrome

86
Q

What enzyme does etomidate inhibit? pt population shouldn’t be used?

A

11 beta hydroxylase
-avoid in sepsis

87
Q

acid base for pyloric stenosis

A

hypoK hypoCl metabolic alkalosis

88
Q

blood volume premature infant

A

90-105 cc/kg

89
Q

blood volume full term nerborn

A

80-90 cc/kg

90
Q

blood volume infant 3-12 months

A

70-80 cc/kg

91
Q

blood volume child 1-12 years

A

70-75 cc/kg

92
Q

blood volume adult male

A

65-70 cc/kg

93
Q

blood volume adult female

A

60-65 cc/kg

94
Q

1 year old ex-28 wker, tracheal balloon dilation, kid req suppl O2, preop test?

A

ECHO!
see if pt has pulm HTN
-high risk of assoc w/ bronchopulm dysplasia and pulm HTN -> needs to be dx to be taken care of correctly in OR

95
Q

Type 1 diaphragm fibers

A

slow-twich, high-oxidative, fatigue-resistant fibers that allow for sustained contractions
-lower in neonates
-50% in adults, kids same at 2

96
Q

Type 2 diaphgram fibers

A

fast-twitch, low-oxidative fibers with quick contractions that fatigue
-higher in neonates, why they fatigue quickly

97
Q

At what age does neonatal diaphgram become adult diaphgram?

A

2 years!
-Prior to 2 years, more fast-twitch type 2 fibers compared to type 1 higher endurance fibers -> why neonates tire quickly

98
Q

Goldenhar syndrome anesthetic concerns

A

-micrognathia, hypoplastic zygomatic arch, facial asymmetry, facial hypoplasia
-congenital cardiac defects
-respiratory problems
-subluxation of C1-2
-normal intelligence usually, disabled 5-15%

99
Q

Intra v extrathoracic airway obstruction flow volume loops

A

The configuration of the flow-volume loop can help distinguish the site of airway narrowing. The airways are divided into intrathoracic and extrathoracic components by the thoracic inlet.
(A) Normal flow-volume loop: the expiratory portion of the flow-volume curve is characterized by a rapid rise to the peak flow rate, followed by a nearly linear fall in flow. The inspiratory curve is a relatively symmetrical, saddle-shaped curve.
(B) Dynamic (or variable, nonfixed) extrathoracic obstruction: flow limitation and flattening are noted on the inspiratory limb of the loop.
(C) Dynamic (or variable, nonfixed) intrathoracic obstruction: flow limitation and flattening are noted on the expiratory limb of the loop.
(D) Fixed upper airway obstruction (can be intrathoracic or extrathoracic): flow limitation and flattening are noted in both the inspiratory and expiratory limbs of the flow-volume loop.
(E) Peripheral or lower airways obstruction: expiratory limb demonstrates concave upward, also called “scooped-out” or “coved” pattern.

100
Q

Dural sac and spinal cord termination in infants

A

L3, S3

101
Q

Why less bradycardia w/ spinal in infants?

A

b/c immature symp NS -> so infants don’t rely on cardiac accelerating fibers (T1-4) for their resting heart rate

102
Q

Why do infants need a larger dose of local anesthesia per kg compared to adults for spinals?

A

Infants have a higher CSF volume on a cc/kg basis
**also why dec PDPH

103
Q

Infant CSF volume

A

4 cc/kg

104
Q

children CSF volume

A

3 cc/kg

105
Q

Adults CSF volume

A

1.5-2 cc/kg

106
Q

continuous machine like murmur at L upper sternal border

A

PDA

107
Q

holosystolic murmur at left sternal border

A

large VSD

108
Q

When do PDA’s usually close in normal infants?

A

10-15 hours after delivery
-inc in O2 and dec PVR, combined w/ dec in prostaglandin -> ductal constriction

109
Q

Ebstein’s anomaly

A

-enlarge RA
-RV hypoplastic/dysfunctional
-abnormal tricuspid valve
-ASD
-R to L shunting
-tricuspid regurge

110
Q

Muscular v Perimembranous VSD

A

Perimembranous: upper ventricular septum close to aortic and mitral valve 70-80% **2nd MC cardiac valve anomaly

Muscular VSD: lower in the ventricular septum in more muscular portion, closer to the apex 20-30% of VSDs

111
Q

Pulmonary atresia

A

-underdeveloped RVOT => resistance of BF towards pulm
-must keep PDA open
-usually assoc w/ other congenital heart dx

112
Q

Bicuspid aortic valve

A

-2 of the valve leaflets fuse during fetal development
-males 4x as likely
-can get AR and AS
-high rate of aortic valve endocarditis

113
Q

what volatile has the highest incidence of emergence delirium?

A

sevo

114
Q

with an increase in MV which will the induction speed increase more for: sevo or iso?

A

iso! b/c more soluble so it makes a bigger difference

115
Q

IV dose of midaz

A

0.05-.1 mg/kg

116
Q

Peds elective surgery healthy, periop fluid guidelines

A

20-40 cc/kg of isotonic solution over 2-4 hours
-**reduces ADH -> limits hypoNa

117
Q

Peds maintenance fluids in 12 hours immediately postop

A

2-1-.5 cc/kg/hr

118
Q

Which peds populations should get dextrose containing solutions?

A

neonates
infants < 6 months
malnourished children
cardiac surgery
glucose 1-2.5%

119
Q

NPO time cereal w/ milk

A

6 hours

120
Q

tx of mild postintubation croup

A

cool, humdified mist

121
Q

tx of moderate-severe postintubation croup

A

nebulized racemic epi -> must be monitored for 4-5 hours to see if rebound effects

122
Q

what can cause postintubation croup

A

sublottic injury and edema w/ traumatic intubation, oversized ETT tube, or overinflated ETT cuff

123
Q

high risk of postop croup uncuffed or cuffed ETTs?

A

uncuffed

124
Q

which pt population is considered high risk for postop croup?

A

down syndrome b/c of subglottic stenosis

125
Q

Maximal allowable blood loss

A

MABL = Est Blood volume * [(starting Hct - minimal acceptable Hct) / starting Hct ]

126
Q

At what age to start u sing cuffed ETT?

A

2 years

127
Q

size of ETT <1500g peds

A

uncuffed 2.5

128
Q

size of ETT 1500g to full term

A

3 uncuffed

129
Q

size of ETT 0-6 months

A

3.5 uncuffed

130
Q

size of ETT 6 months - 1.5 years

A

4 uncuffed

131
Q

ideal leak pressure of an uncuffed ETT in peds

A

20-30
-if > 40 -> replace with smaller ETT

132
Q

equation for ETT in peds

A

age/4 + 4

133
Q

where is the umbilical cord w/ omphalocele

A

at apex of herniated sac (covered by amniotic membrane/sac NOT SKIN)

134
Q

where is the umilical cord w/ gastroschisis

A

not covered by membrane, so to the side of the gastroschisis (not covered by anything)
**occurs later in development, so associated abnormalities are rare

135
Q

Assoc w/ ompahlocele

A

-trisomies: 13, 18, 21
-Beckwith-Wiedemann syndrome
-cardiac valve issues
-intestinal/anal atresia
-cleft palate
-neural tube defects
-urogenital prob

136
Q

infant lung/chest compliance

A

less lung compliance than adults (fewer alevoli and less elastin)
higher chest wall compliance than adults (ribs more cartilage)
-at 2 normalizes

137
Q

Airway differences in infants

A

Larger occiput
obligate nose breathers
relatively larger tongues
longer epiglottis
shorter trachea
more cephalad larynx (C3-4)

138
Q

Where is larynx in infants?

A

C3-4 (more cephalad than adults)

139
Q

Where is layrnx in adults?

A

C5-6 (More caudad than infants)

140
Q

Most commonn congenital heart diseases

A
  1. MC: bicuspid aortic valves
  2. VSD: perimembranous
  3. VSD: muscular
  4. ASD: secundum
  5. ASD: primum
141
Q

RF for postop apnea

A

hx of prematurity
post conceptual age < 60 weeks
-hx of apnea
-**anemia (Hct < 25-30%)

142
Q

Multiple Organ Dysfunction Syndrome

A

When functinoal abnormalities persist in 2 or more organs
-prevention: early detection and treatment of sepsis

143
Q

Therapy for phantom limb pain

A

Mirror therapy
-TCA, anticonvulsants, gabapentin, ketamine, memantine, opioids
-PT, massage, TENS, acupuncture

144
Q

permanent pacemaker indications:

A

2nd degree Type II AV block
3rd degree AV block
symp bradyarrhythmia
refractory SVT
-high risk pts w/ congenital long QT syndrome
-cardiomyopathy benefiting from resynchronization therapy -> HOCM and dilated cardiomyopathy

145
Q
A

severe hypocalcemia

146
Q

reasons for oligura intraop

A

-PPV -> inc IVC pressure -> dec perfusion to kidneys
-dec venous return b/c PPV -> dec preload -> inc ADH, dec ANP, dec cardiac output -> RAAS -> fluid retention
-PPV -> release of inflammatory mediators -> AKI

147
Q

dhow much higher of an affinity does CO have for Hg compared to O2?

A

200-300

148
Q

Platypnea

A

hypoxia imrpved when pt lies flat
hepatopulm syndrome

149
Q

orthodeoxia

A

hypoxia worsens when pt stands up
hepatopulm syndrome

150
Q

Pathophys behind hepatopulm syndrome

A

-so the ESLD build up of nitric oxide -> vasodilation in pulm vasculature -> worsened V/Q mismatch (inc perfusion) -> pt standing worsening hypoxia b/c blood shifts, but better oxygenation when laying flat b/c of gravity and where blood is distrubted

151
Q

Fundoscopic exam shows narrowed retinal arteries and cherry red macula, blindness in one eye after spine surgery? dx?

A

retinal artery occlusion 2/2 rasied IOP due to external eye compression -> ischemic to the retinal artery

152
Q

Ischemic optic neuropathy v central retinal artery occlusion

A

ION is b/l, central retinal artery occlusion is unilateral
-you can have central retinal artery occlusion from ischemic compression
-fundoscopic exam in central retinal artery occlusion shows a cherry red macula

153
Q

Dx of hepatopulm syndrome

A

sitting position abnormal A-a gradient > 20 with PaO2 < 60
-contrast-enchanced echo confirms intrapulm vasodilation

154
Q

decrescendo diastolic murmur with inc pulse pressure

A

aortic regurge

155
Q

Aortic regurgitation hemodynamic goals

A

decreasing afterload
maintaing a high normal HR
maintaing contracility

156
Q

What ETTs should be used and avoided we/ CO2 lasers

A

Used: meta wrapped or flexible metal
avoid: polyvinyl chloride

157
Q

What ETT should be used for Nd:YAG lasers?

A

silicone-based and rubber shafts w/ silver foil and sponge coatings

158
Q

What causes an increase in peak inspiratory pressure but no change to plateau pressure?

A

-airway secretions
-bronchospasm
-kinked ETT
-mucus plug

159
Q

What causes an increase in peak inspiratory pressure and plateau pressure?

A

-abd insufflation
-ascites
-pulm dx
-tension PTX
-trendelenburg positioning

160
Q

What affects peak inspiratory pressure?

A

airway resistasnce!
-including tubing, ETT, and terminal BRONCHI!!
-bronchospasm will lincrease

161
Q

What affests plateau pressure

A

pulmonary compliance! lungs and alveoli
-if issue w/i the lungs it will increase

162
Q

Where are sympathetic presynatic n cells located?

A

T1-L2

163
Q

Horner Syndrome

A

-sympathetics blocked
-Miosis (constricted pupil)
Ptosis (droopy eyelid)
ANhidrosis (can’t sweat)

164
Q

What sympathetic block to do for abd cancers?

A

celiac plexus (L1)

165
Q

Sympathetic N Block indications

A

-arterial/venous occlusion (get vasodilation)
-raynaud’s
-vasospasm
-venous insuff
-phantom limb pain
-CRPS
-abd cancer
-chronic pancreatitis
-refractory angina
**VISCERAL PAIN, neuropathy pain

166
Q

Nitroprussive: arterial v venous vasodilation?

A

both
-why can get coronary steal -> blood shunts away from occlused vassesls -> MI

167
Q

nitric oxide: arterial v venous vasodilation

A

venous!

168
Q

hydralazine: arterial v venous vasodilation

A

arterial selective

169
Q

sodium nitroprusside and the brain

A

profound cerebral vasodilator -> inc CBF
-however that combined w/ dec SVR -> can cause cerebral ischemia

170
Q

Meds that commonly cause drug fever

A

-amphoterician
-cephalosporins
-PCN
-phenytoin
-procainamide
-quinidine
-hydralazine

171
Q

Inhalational induction: pregnant versus non-pregnant

A

faster in pregnant b/c
-dec FRC
-inc minute ventilation
-Dec MAC requirements

172
Q

inhalational induction & FRC

A

-inhalational induction is inversely related to FRC
-b/c FRC is air in lungs at end of passive exhalation -> considered to be the lung volute diluting volatile anesthetics

173
Q

Inhalational induction w/ emphysema

A

-emphysema has inc FRC -> inc dilution -> slower FA/Fi -> shower inhalational induction

174
Q

Aortic insufficiency aka

A

aortic regurgitation

175
Q

Why MI w/ acute aortic regurge?

A

-dec aortic diastolic BP -> dec coronary perfusion
-b/c regurge inc volume and pressure on LV -> hypertrophied -> bigger O2 demand

176
Q

Acute aortic insuff tx

A

Dobutamine and nitroprusside -> inotropic w/ vasodilator to inc LV contraction and dec afterload

177
Q

Chronic aortic insuff tx

A

Nifedipine or hydralazine

178
Q

Aortic insuff hemodynamic goals

A

fast, full, forward
-avoid bradycarida
-full preload
-avoid afterload inc

179
Q

dec in sensation in distal upper extremities and dec pain sensation after MVA

A

syringomyelia
-loss of pain and temp sensation, but maintains proprioception, touch, and vibration

180
Q

imaging of choice for retained epidural catheters

A

CT scan!
-metals in some catheters will screw w/ MRI and can cause burning / tissue damage

181
Q

What to do after imagingn if pt has retained cather?

A

-if no symptoms -> leave in place
-if symptoms -> neurosurg consult

182
Q

Factosr that inc likelihood of epidural catheter breakage

A

-faster speed of removal
-inserting more catheter than nneeded
-removing catheter in diff position than it was placed

183
Q

What to do if epidural catheter is difficult to remove?

A

-extreme flexion of spine w/ rapid injection of small amount of saline
- wind epidural around tongue blade, tape to pt, and then every 15 minutes turn it a little lighter

184
Q

Preop prep for pheo

A

-alpha blockade 10-14 days prior to surgery
-ensure normovolemia
-add beta blockers if already alpha blocked and persistent tachycardia, HTN or dysrhythmias

185
Q

Which muscle is innervated by SLN?

A

cricothyroid

186
Q

What type of heat loss higher in infants and why?

A

radiation and convective b/c infants have a higher surface area to body mass ratio

187
Q

During non-shivering thermogenesis in infants what % of cardiac output is directed to the brown fat tissue?

A

up to 25%

188
Q

inhalational anesthetics and nonshivering thrmogeneiss

A

-inhaled anesthetics inhibit it w/ 5 min of exposure, and after it’s done takes 15 min to restart

189
Q

Normal mixed venous

A

75%

190
Q

mixed venous and cardiac output

A

inc in cardiac oputput -> inc in SvO2
-dec in cardiac output -> dec in SvO2

191
Q

Asymptomatic SVT in pregnancy

A

-vagal maneuvers 1st
-Adenosine

-onlyl use digoxin, CCB or BB if adenosine failed

192
Q

How does adenosinen work?

A

Transiently blocks the aV node

193
Q

Hyperaldosteronism acid-base?

A

hypoK metabolic alkalosis

194
Q

tx for hyperaldo

A

-spironolactone or triamterene and K repletion
-surgery -> avoid hypervent will make hypoK worse

195
Q

Signs of successful stellate ganglion block

A

-flushing of conjunctiva and skin of the face and arm
-horner syndrome (miosis, ptosis, anhidrosis)
-nasal congestion
-temp inc in ipsilateral arm

196
Q

Common SE of stellate ganglion block

A

-globus sensation (feeling of lump in throat)
-recurrent laryngeal n block
-horner syndrome

-rare: sz injxn into veretebral arery or complte spinal (spinal injxn)

197
Q

how to do cervical in line stablization

A

goal: stabilize apical and basal cervical spine
-one operator: maintains head and neck in neutral position
-2nd operator: stabilizes shoulders against the OR table, bed or stretcher
-3rd person DLs

Truelearn Advanced Exam (15 decks)

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