Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Truelearn Advanced Exam > TL block 7 > Flashcards

TL block 7 Flashcards

1
Q

CAM-ICU questions

A
  1. acute change in mental status or fluctuating?
  2. pt inattentive or easily distracted?
  3. RASS other than zero?
  4. disorganized thinking?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

trigger point myofascial pain

A

-limited ROM
-muscle spasm upon palpation
-radiation of pain to somewhere else w/ palpation
-palpation can cause autonomic symp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Concerns for ACLS in pregnant patients

A

if >20 weeks
-L displacement of uterus w/ compressions
-Same energy charge for defib
-delivery of fetus in 4 minutes if no ROSC
-if Mg running, stop and give calcium
-have LMAs available incase ETT is too difficult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Common SE w/ interscalene blocks

A

-ipsilateral Hornor syndrome (stellate ganglion blocked) -> ptosis, miosis, anhidrosis
-ipsilateral phrenic n blocked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Asthma DLCO

A

Increased
-inc lung volumes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

exercise DLCO

A

increase! b/c cardiac output is increased -> more flow through pulm vessels -> more Hg in lungs -> Inc DLCO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

L to R cardiac shunt DLCO

A

increased
-more blood going to lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What determines DLCO?

A

-blood flow (cardiac output)
-Hg conc
-lung parychema (fibrosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Zenker’s diverticulum

A

CI to TEE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Absolute contraindications to TEE

A

-Zenker diverticulum
-Active GI bleed
-esophageal tumor
-recent esophageal surgery
-Mallory Weiss tear
-Scleroderma
-perforated esophagus
-esophageal rings/strictures/webs
-esophageal trauma
-recent variceal bleeding
-esophagectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

RF for MR following acute MI

A

-adv age
-inferior/posterior MI
-extending infarct
-hx of prior MI
-multiple vessel CAD
-recurrent ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Setting of power failure, what works and what doesn’t?

A

Works: O2 delivery, manual PPV, if vaporizers variable-bypass they will work
doesn’t: monitoring, all electrical, or if cassette vaporizers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Anion Gap Equation

A

Na - (Cl + bicarb)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of non-anion gap metabolic acidosis

A
  1. Giving Cl -> excessive NS, TPN
  2. GI/renal losses of bicarb: renal tubular acidosis, acetazolamide, diarrhea, high ostomy output
  3. Dec acid secretion -> hyperaldo, renal tubular acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

surgical blood loss replacement in neonates

A

1:1 colloid (blood, albumin)
1:1.5 isotonic crystalloid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

when to restart subq 5k BID heparin after catheter?

A

immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how long to hold heparin 5k BID before catheter removal?

A

4-6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how long to restart heparin 5k BID after catheter removal?

A

immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

heparin 7.5k-10k BID how long to hold before epidural?

A

12 hours AND normal coag status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

heparin 7.5k-10k BID when to restart after neuraxial?

A

avoid if catheter in place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

heparin 7.5k-10k BID when to restart after catheter removal?

A

immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Therapeutic subq heparin > 20k per day: when to hold before neuraxial?

A

24 hours AND normal coags

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Therapeutic subq heparin > 20k per day: when to restart once epidural placed?

A

avoid if catheter in place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Therapeutic subq heparin > 20k per day: when to restart when catheter removed?

A

immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

IV UFH: when to hold prior to neuraxial?

A

4-6 hours AND normal coags

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

IV UFH: when to restart once catheter in place?

A

1 hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

IV UFH: how long to hold before catheter removal?

A

4-6 hours AND normal coags

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

IV UFH: how long after catheter removal can we restart?

A

1 hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

LMWH ppx daily how long to hold before neuraxial?

A

12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

LMWH ppx daily how long to wait after catheter placed to restart?

A

12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

LMWH ppx daily how long to hold before catheter removal?

A

12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

LMWH ppx daily, how long to wait to restart after catheter removal?

A

4 hours
and NO no earlier than 12 hours after catheter placement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

LMWH ppx BID dosing:how long to hold before neuraxial?

A

12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

LMWH ppx BID dosing: how long to wait to restart after catheter in place?

A

Avoid while catheter in place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

LMWH ppx BID dosing: how long after catheter removed to wait until restarting?

A

4 hours AND no earlier than 12 hours after initial catheter placement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Therapeutic LMWH dosing: how long to hold before catheter placement?

A

24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Therapeutic LMWH dosing: how long to wait to restart after catheter placed?

A

avoid if catheter in place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Therapeutic LMWH dosing: how long to wait to restart after catheter removed?

A

4 hours AND no earlier than 12 hours after intial placement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Complications of refeeding syndrome

A

-weakness (incl resp weakness)
-myocardial depression
-rhabdo
-hemolytic anemia
-arrhythmias
-neuro disturbances
-impaired O2 delivery
-immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Situations that worsen refeeding syndrome:

A

-hyperventilation: low CO2 causes intracellular shift of phosphate
-inc renal elimination of phos: hyperPTH, loop diuretics
-dec phos absorption: Vit D def

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Normotensive pt, most effective way to reduce inc ICP

A

propofol bolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

post-craniotomy 3d ago, now new surgery nitrous during case, post op not following commands or waking up, dx? next steps?

A

Dx: tension pneumocephalus
next step: CT scan
tx: neurosurg air loculi aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

if HIPPA breached, next steps?

A

Pt must be notified up to 60 days after date of discovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

if breach of pt information affected more than 500 individuals next steps:

A

-notify individuals
-US Dept of Health & Human services notified
-prominent media outlet in the sate or jurisdiction where breach happened

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Allodynia

A

perception of ordinarily nonnoxious stimulus as painful
(touch of clothes as painful)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Anesthesia dolorosa

A

pain in an area that lacks sensation
(after trigeminal neurolytic block)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Difference between mixed venous O2 saturation and central venous O2 saturation

A

mixed venous: taken from pulm artery catheter
central venous: taken from central line
-central venous is 2-5% less than mixed venous b/c high extraction of head and upper extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Direct inhibitors of hypoxic pulmonary vasoconstriction

A

-hypocarbia
-infxn
-vasodilators (NG, nicaridipine, nitroprusside)
-metabolic alkalosis
-volatiles at greater than 1 MAC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Microcirculation and cardiogenic shock

A

-due to pump failure -> venous congestion
-to compensate we get arterial vasoconstriction
-b/w capillaries and organ interstitium -> favor of fluid movement into intersititum and then capillaries become leaky and also favor fluid movement into interstitium -> but reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

LWhat is octreotide used for?

A

Acromegaly: suppresses GH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Where is lumbar sympathetic ganglia located?

A

L1-L5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What symp n block causes diarrhea?

A

Celiac plexus (T5-12)
-innervation to intraabd organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Tetralogy of Fallot

A

-VSD
-overriding aorta
-RVOT obstruction
-Right ventricular hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Tet spells steps!

A

tet spell: shifted to R->L shunting of blood
1st step: give O2 and bend legs, squat (inc SVR to promote BF to pulm, O2 pulm vasodilation)
2nd step: IVF and narcotic like morphine (inc preload, dec HR, dec PVR, dec RR)
3rd step: beta blocker (dec HR, improve preload, relax RVOT obstruction)
4th step: phenylephrine (inc SVR, promote blood flow)
5th: ECMO, emergency surgical repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

treatment if pt w/ tetralogy of fallot starts to experience heart failure

A

digoxin and loop diuretics
-goal to maintain SVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Def of wide complex QRS

A

> 0.09 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

energy for synchronized cardioversion in peds

A

0.5-1 J/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

unstable wide complex tachycardia

A

synchronized cardioversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

sinus tachycardia v SVT in peds

A

sinus: p waves
-HR < 220 for infants
-<180 for children
-<150 for adults

SVT: no p waves
HR >220 infants, >180 peds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

posterior fossa surgery, acute HTN and bradycardia w/ retraction why?

A

Brainstem compression -> cushings triad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Once pt gets diabetic neuropathy, what’s next?

A

depression of reflexes -> motor weakness
-autonomic neuropathy -> sluggish pupillary light reflexes, gustatory hidrosis (lots of sweating at head and upper torso after meals)
-resting tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

superior laryngeal nerve

A

innervated cricothyroid muscle (VC adductor)
-so if RLN damage -> VC adduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Meds to avoid w/ myotonic dystrophy

A

-neostigmine
-succinylcholine
-K containing solutions

**shivering will also cause myotonias!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Lab findings primary hyperparathyroidism

A

-hyperCa
-hypoPhos
-non AG metabolic acidosis (dec bicarb reabsorption)
-normal to high 24hr urinary calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

post parathyroidectomy, weak voice mild neck discomfort in PACU, next morning voice sounds different and weakens after speaking for a long time

A

superior laryngeal n injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Most common n injured in parathyroid/thyroidectomy

A

superior laryngeal n

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

SIADH dx criteria

A

hypoNa w/ urine Na > 20
-inc urine osm while dec serum osm
-euvolemic/hypervolemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How to tell SIADH apart from cerebral salt wasting

A

volume status!
SIADH: euvolemic
cerebral salt wasting: hypovolemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Diabetes insipidus labs

A

-either ADH not produced or kidneys not responsive
-hyperNa (>145), hyperosm blood, (>305) urine low sodium, urine low osm (<300)
-usually euvolemic, can easily become hypovolemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

normal urine osmolality

A

500-850

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

normal urine specific gravity

A

1.005-1.030

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

infant blood transfusion, when to start?

A

Hct <20 if hemostasis achieved
Hct < 25 if additional bleeding still expected
-initial volume of 10-15 cc/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

maximum allowable blood loss eq

A

MABL = est blood volume * ([starting Hct - target Hct] / starting Hct)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

how much does 1u PRBCs raise Hg or Hct in adults?

A

Hg inc 1
Hct inc 2-3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Peds 10-15 cc/kg pRBC raise hg or hct in adults?

A

hg inc 1
Hct inc 2-3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

How to tell MH apart from thyroid storm

A

Hypercapnia
inc CK
lactic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Thyroid storm treatment

A

propthiouracil and supportive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

lab values in Addison’s dx

A

primary adrenal insuff
-hypoNa, hyperK, metabolic acidosis, hyperCl, hypoglycemia, hyperCa
(hypercalcemia due to dec in GFR 2/2 hypovolemia with an increase in Ca release from the bone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Prazosin MOA

A

selective alpha 1 blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

why inc HR w/ phenoxybenzamine

A

non-selective alpha blockade -> loss of alpha 2 presynaptic inhibition of norepinephrine release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

if pt has a tracheoesophageal fistula, what other anomaly is most likely in this child?

A

congenital heart defects

82
Q

Which electrolyte is inc w/ TPN?

A

calcium

83
Q

Pierre Robin

A

cleft palate
micrognathia
glossoptosis
congenital heart disease

84
Q
A

Treacher Collins syndrome
micrognathia
aplastic zygomatic arches
microstoma
choanal atresia
congenital heart dx
-treacher like teacher, the movie with the congenital kiddo -> micgronathia, ears, no arches

85
Q
A

Goldenhar syndrome
-unilateral facial hypoplasia
congenital heart dx
eye,ear, and vertebral anomalies on affected side

86
Q

Hunter or Hurler Syndrome

A

-mucopolysaccharidoses
-upper airway obstruction
-difficult intubation 2/2 infiltration of lymphoid tissues
-macroglossia
-small mouth opening
-excessive thick secretions

87
Q

congenital craniofascial synostosis, maxillary hypoplasia, beaked nose

A

Crouzon syndrome

88
Q

hypoCa EKG

A

prolonged QT

89
Q

ideal spinal level for a TURP

A

T10

90
Q

Benefits of regional v GA for TURP

A

-better immediate resp if bladder rupture
-dec bleeding (dec CVP)
-dec DVT

no change in cognitive fxn

91
Q

Primary hyperthyroid test results

A

-inc free T3, T4
-dec/normal TSH
-inc thyroid hormone binding ratio

92
Q

ETT v LMA in setting of peds URI

A

ETT causes more stimulation to inflamed airways -> carries more pulm risks than LMA

93
Q

Treatment for severe hyperCa or acute moderate hyperCa

A

IVF!
-calcitonin (ca excretion too) to dec bone reabsorption, osteoclas inh (onset 4-6 hours) -> can lower 1-2 mg/dL -> tachyphylaxis only works first 48 hours
-bisphosphonates to dec bone reabsorption (takes 24-28 hours to work) -> ex: Zoledronic acid

94
Q

Zoledronic acid

A

bisphosphonate that prevents bone reabsorption
-takes 24-72 hours to start working

95
Q

RF for allergic contrast reaction

A

-allergic to other medications
-asthma
-hx of previous reaction to contrast

–> recommendation prednisone course beforehand

96
Q

What inhibits nonshivering thermogenesis

A

BETA BLOCKERS
inhalational anesthestics

97
Q

what triggers nonshivering thermogenesis

A

Norepinephrine
Thyroxine
Glucocorticoids

98
Q

Present 4-12 hours after pituitary surgery, post op, polyuria, polydipsia

A

central diabetes insipidus
tx: exogenous ADH

99
Q

peds XR retropharyngeal soft tissue widening

A

retropharyngeal abscess

100
Q
A

Croup

101
Q
A

Epiglottitis

102
Q
A

retropharyngeal abscess

103
Q

pretreatment for hyperK periodic paralysis

A

Acetazolamide, thiazides
-if severe: insulin and glucose

104
Q

lid lag: hyper/hypothyroid?

A

hyperthyroid

105
Q

number of beta adrenergic receptors inc: hyper/hypothyroid?

A

hyperthyroid -> why you get an overstimulation of sympathetic NS

106
Q

onycholysis: hyper/hypothyroid?

A

hyperthyroid
nail separates from nail bed

107
Q

delayed relaxation of deep tendon reflexes: hyper/hypothyroid?

A

hypothyroid

108
Q

prior to robotic surgery, what testing does someone w/ polycystic kidney disease need?

A

CT angio of the head
-more likely to have berry aneurysms -> and steep positioning of robotic surgery inc ICP

109
Q

hyperK EKG

A

peaked T waves, but also ST depressions

110
Q

hypoNa severe EKG changes

A

widening of QRS, ST elevation

111
Q

hypercalcemia EKG

A

prolonged PR, shortened ST and QT interval

112
Q

hyperparathyroidism causes

A
113
Q

early post HD period

A

-hypoK
-dry weight, euvolemic or hypovolemic
-can have inc PTT due to heparin used in HD

114
Q

Lytes in chronic ESRD

A

HyperK
HyperMg
Hyperphos
HypoCa
Anemia
hyperlipidemia
HTN
2ndary hyperparathyroidism

115
Q

CA 19-9 levels used to dx

A

pancreatic cancer

116
Q

CEA levels used to dx

A

colon cancer

117
Q

5-hydroxyindoleacetic acid in urine

A

Serotonin syndrome

118
Q

Urine metanephrines

A

pheochromocytoma

119
Q

Carcinoid syndrome triad

A

flushing
asthma
R sided heart disease

120
Q

Right marginal artery supplies

A

Lateral RV and cardiac apex

121
Q

Blood supply for anterolateral papillary muscles

A

LCx and LAD

122
Q

Blood supply for posteromedial papillary muscle

A

RCA

123
Q

Where do the intercostal nerve, artery, veins run?

A

inferior surface

124
Q

Complications of intercostal n blocks

A

-PTX
-high systemic absorption of local anesthetics -> toxicity esp if multiple levels or catheters are used

125
Q

McConell’s sign

A

akinesis of the mid-free RV wall w/ preserved RV apical motion
-specific for PE

126
Q

succ, cricoid pressure, LES tone

A

succ inc LES tone
cricoid pressure dec LES tone

127
Q

contraindications to cricoid pressure

A

cervical spine fracture
laryngeal fracture
active vomiting

128
Q

Sphenopalatine ganglion innervation

A

nasal cavity mucosa, hard palate, lacrimal gland

129
Q

Infraorbital nerve innervates

A

lateral aspect of skin overlying the nose, cheek, and upper lip
(blocked for cleft lip)

130
Q

zygomaticofacial nerve

A

innervation of the cheek

131
Q

retrobulbar block -> severe left ocular pain, no increase in intraocular pressure

A

puncture of the posterior globe

132
Q

closing of upper eyelid, proptosis, and increase in intraocular pressure

A

retrobulbar hemorhage

133
Q

oculocardiac reflex, afferent, efferent

A

afferent: trigeminal nerve (V1)
efferent: vagus

134
Q

bicarb + ropi/bupi=

A

precipitant formation

135
Q

pH for local anesthetic

A

time of onset

136
Q

what lumbar branches make up iliohypogastric?

A

T12-L1

137
Q

what lumbar branches make up ilioinguinal?

A

L1

138
Q

what lumbar branches make up genitofemoral?

A

L1, L2

139
Q

what lumbar branches make up LFCN

A

L2, L3

140
Q

what lumbar branches make up obturator n?

A

L2-L4

141
Q

what lumbar branches make up femoral nerves?

A

L2-L4

142
Q

what branches make up the sciatic nerve?

A

L4-S3
-spared w/ lumbar plexus block

143
Q

current to get a stimulus which indicates intraneural?

A

< 0.3 mA

144
Q

which color lead should be attached to needle?

A

black (cathode)

145
Q

What type of stimulus is preferred to give for a nerve block?

A

Square wave stimulus

146
Q

What stimulating current is ideal for nerve block?

A

0.4-0.5 mA

147
Q

common peroneal n twitch

A

foot eversion
dorsiflexion

148
Q

tibial n stimulation twich

A

foot inversion
plantarflexion

149
Q

if trying to block tibial nerve, and semimembranosus twitch

A

redirect medially
BF: biceps femoris
G:gastrocnemius
SM: semimembranosus
ST: semitendinosus

150
Q

if trying to block tibial nerve and biceps femoris twiches

A

redirect medially

BF: biceps femoris
G:gastrocnemius
SM: semimembranosus
ST: semitendinosus

151
Q

Which nerves affected by TAP block?

A

intercostal
subcostal
ilioinguinal
iliohypogastric

152
Q

structures?

A
153
Q

resurge of motor weakness 8 hours after termination of lumbar epidural, dx?

A

epidural hematoma -> get MRI

154
Q

development of urinary incontinence and back pain days after epidural placement

A

epidural abscess -> cauda equina syndrome
**time frame -> DAYS

155
Q

What upper extremity block has the highest rate of PTX?

A

Supraclavicular

156
Q

Most common complication of supraclavicular n block?

A

phrenic nerve blockade

157
Q

Meralgia paresthetica

A

entrapment of LFCN
-assoc w/ burning pain over the distribution

158
Q

structures gone through for a spinal

A

skin
subcutaneous tissue
supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space
dura mater

159
Q

When is a cervical plexus block used?

A

Surgeries in C2-C4 distribution
-LN dissection/ CEA

160
Q

Complications/side effects of deep cervical plexus block

A

-blockage of phrenic and superior laryngeal nerve
-spread of local anesthesia into epidural and subarachnoid spaces
-intravascular injxn

161
Q

anatomic landmarks for deep cervical plexus block

A

posterior sternocleidomastoid
-transverse process of C6 (Chassaignac tubercle)
-mastoid process

162
Q

what boarders musculocutaneous n at axillary n block location?

A

b/w biceps and coracobrachialis

163
Q

when performing an interscalene n block, what n is transversed?

A

middle scalene

164
Q

b/l RLN injury: partial vs complete

A

complete: VC both being inn a paramedian position causing aphonia and aspiration risk

partial: COMPLETE obstruction -> unopposed adduction of vocal cords

165
Q

What can you add to peribulbar or retrobulbar blocks to reduce inc in orbital pressure from injected volume, enhanced quality of block, and dec change of injury to muscles?

A

hyaluronidase

166
Q

ankle block: what nerve is posterior to the tip of the medial malleolus?

A

posterior tibial nerve
-motor and sensory innervation to the plantar aspect of the foot

167
Q

RF for PDPH

A

age < 40
prior PDPH
BMI < 30
hx of air travel
muliple dural attempts
cutting needle (Quinke)

168
Q

obturator block

A

between the adductor longus and brevis muscles
ALABAMa
superifical to deep
Adductor Longus
Adductor Brevis
Adductor Magnus

169
Q

labor spinal/epidural, BP corrected and still nauseous, tx?

A

Atropine or Glyco! Glyco doesn’t cross placenta
-unopposed parasymp -> inc in gut paristalsis -> nausea

170
Q

Ankylosing spondylitis anesthesia concerns

A

-inc risk of epidural hematoma (multiple attempts, long-standing NSAID use affecting plts)
-difficult DL (dec ROM due to disc ossification) -> atlantoaxial instability
-difficult mask ventilation (TMJ hypomobility)

171
Q

borders of the femoral triangle

A

medially: adductor longus
laterally: sartorius
superiorly: inguinal ligament

172
Q

if unsure where tip of catheter is and getting fluid return, best test to distinguish b/w saline and CSF?

A

glucose test
-CSF has glucose, saline does not
-point of care test, quick

173
Q

conc and volume for a bier block

A

40-50cc 0.5% lido

174
Q

Why dec BP after spinal

A

sympatectomy -> venous vasodilation and dec preload

175
Q

what cell type produces surface-active lipoprotein?

A

type II alveolar cells

176
Q

What are type I alveolar cells?

A

Flattened, thin-walled squamous cells covering 80% of alveolar surface

177
Q

type III alveolar cells

A

alveolar macrophages

178
Q

Most common risks of TPN

A

-thrombophlebitis
-infxn (MC)

179
Q

what ulcer ppx providers better protection against ventilator assoc PNA?

A

sucralfate
-b/c doesnt change pH of gastric fluid

180
Q

MOA of carbon monoxide positioning

A

inhibition of mitochondrial cytochrome oxidase

181
Q

EKG tricyclic antidepressant OD

A

prolonged QRS interval

182
Q

Strong Ion Difference

A

SID = (Na + K + Ca + Mg) - (Cl + lactate)

-dec in SID = acidosis
-inc in SID = alkalosis
-if you dilute plasma -> decreases SID

183
Q

normal strong ion difference

A

40-42

184
Q

SID and pH

A

INC SID = INC in pH

185
Q

screening test for C diff

A

nucleic amplification for glutamade dehydrogenase

186
Q

confirmatory test for C diff

A

toxin enzyme immunoassay

187
Q

first line treatment for CN toxicity

A

hydroxocobalamin

188
Q

Parkland formula for burns

A

4 x kg x % burned (use whole number not decimal)
-1/2 should be the 1st 8 hours, and then remaining over the next 16 hours

189
Q

EKG changes and phosphate

A

hyperphos: prolonged QT

190
Q

When should TPN be started?

A

AT LEAST 7 days after ICU admission

191
Q

Why do you get hypoPhos w/ TPN?

A

w/ glucose loading w/ TPN -> inc in intracellular movement of phosphate

192
Q

Absolute contraindications to percutaneous tracheostomy

A

-infants
-insertion site infection
-severe/uncontrolled coagulopathy
-unstable cervical spine injury

193
Q

Signs of propfol infusion syndrome

A

impaired free fatty acid utilization and impaired mitochondrial activity -> inadequate aerobic metabolism
-metabolic lactic acidosis
-cardiac failure
-renal failure
-rhabdo
-hyperK
-hyperTG
-hepatomegaly
-pancreatitis (inc TG)

194
Q

Early onset ventilator assoc PNA (24-72 hrs)

A

MSSA
H influenza
Strep PNA
-Proteus, Klebsiella, Enterobacter

195
Q

late onset vent assoc PNA

A

MRSA
Pseudomonas
Acinetobacter

196
Q

Treatment for botulism

A

> 1: Equine-derived antitoxin
<1: human dervied immune globulin

197
Q

How do neuraxial opioids work?

A

then work at the mu opioid receptors in the substantia gelatinosa spinal cord dorsal horn
-inhibit release of substance P and glutamate
-hyperpolarized postsynaptic nerve

198
Q

frequency of blood moving towards u/s probe

A

higher than the frequency of the u/s probe

199
Q

frequency of blood moving away from u/s probe

A

lower frequency than the u/s probe

200
Q

pts at higher risk of jaundice w/ multiple pRBC transfusions

A

Gilbert Syndrome

201
Q

When are phrenic nerve stimulators used?

A

cranial or cervical spinal cord injuries -> used to improve lung function and reduce atelectasis -> higher rates of weaning from ventilator support

202
Q

side effects of phrenic nerve stimulators

A

-infxn
-dislodgement w/ neck movement
-paradoxical chest movement in peds (inc chest wall compliance)
-phrenic n injury

Truelearn Advanced Exam (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions