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truelearn advanced exam > TL block 9 > Flashcards

TL block 9 Flashcards

1
Q

How to blunt inc in ICP w/ laryngoscopy?

A

Lidocaine 1.5 mg/kg

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2
Q

Myasthenic syndrome and myasthenia gravis: gender influences

A

Myasthenic syndrome more likely in males
myasthenia gravis more likely in females

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3
Q

Myasthenic syndrome v myasthenia gravis: more likely to have proximal limb weakness

A

myasthenic syndrome

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4
Q

Myasthenic syndrome and myasthenia gravis: reflexes

A

myasthenic syndrome: absent/ dec reflexes
MG: normal reflexes

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5
Q

Treatment for myasthenic crisis

A

-IVIG
-plasmapheresis
-steroids
-AChE inhibitors
-immunosuppressant agents

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6
Q

With AVM resections and neuromonitoring, best way of assessing tolerance to vessel clamping in parietal lobe

A

SSEPs or MEPs

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7
Q

What is Demeclocycline used for?

A

Treatment for SIADH

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8
Q

What is cabergoline used for?

A

Dopamine agonist -> prolactinoma

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9
Q

What is Calcitriol used for?

A

to treat hypoCa in hypoparathyroidism

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10
Q

subarachnoid hemorrhage and Hg

A

Admission Hg -> predictor of cerebral infarction and outcomes

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11
Q

Where does deep brain stimulation target for tx of Parkinson’s Dx?

A

Subthalamic Nucleus
Internal Globus Pallidus

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12
Q

why aneurysm rupture w/ dec in CSF?

A

Cerebral perfusion pressure = MAP - ICP -> loss of CSF dec ICP extensively -> inc transmural pressure across wall of aneurysm -> rupture

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13
Q

Why ST changes w/ subarachnoid hemorrhage?

A

inc circulating catecholamines -> demand ischemia

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14
Q

Hydrocephalus and EKG

A

QTc prolongation

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15
Q

if pt has spinal cord injury and will likely fail extubation, next steps?

A

Trach w/i 7-10 days of injury to reduce sedation needs, red mechanical vent days, improve pulm toilet, and participate in therpay

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16
Q

Predictors of complications w/ ICD lead extraction

A

-leads in place for longer period of time
-inexperienced physician
-laser extraction
-pt is female
-larger # of leads requiring extraction

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17
Q

Treatment for SVT w/ Wolf-Parkinson White

A

Procainamide
-slows down conduction in the accessory pathway w/o affecting the AV Node

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18
Q

What happens if you give someone w/ Wolff-Parkinson White Adenosine?

A

Slows conduction at the AV node -> instead heart conducts through the accessory pathway -> v fib -> cardiac arrest

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19
Q

RF for sudden death from congenital long QTc

A

-QTc > 500
-female
-male w/ QT3
-deafness
-widened T waves

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20
Q

Acute management of congenital prolonged QT

A

-IV Mag
-replace Ca, K
-AVOID amiodarone

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21
Q

Long term management of long QT syndrome

A

-beta blocker
-PM/AICD
-L stellate sympathectomy if refractory

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22
Q
A

A: furosemide
B: ACE inh, NG
C: milrinone
D: NE, epi

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23
Q

centrifugal v roller pumps in CPB: which varies w/ changes in pump preload and afterload

A

centrifugal

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24
Q

which coronary artery is most likely to get an air embolism w/ open heart surgery?

A

RCA

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25
Q

Why hypoTN w/ protamine?

A

Histamine release

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26
Q

Treatment for vasoplegia w/ CPB?

A

Vasopressin and methylene blue

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27
Q

what TEE view is used to assess accurate placement of the femoral catheter for CPB

A

mid-esophageal bicaval view

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28
Q

What would you want to look at if you used a transgastric short axis view?

A

cross section of LV and RV -> assess thickness, contractility, volume status

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29
Q

what is seen in the mid-esophageal long axis view?

A

LA, MV, LV, LVOT, AV, ascending aorta

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30
Q

What is an esophageal detector device and hows it work?

A

It’s a ballon, you squeeze it, if in the lungs reinflates, if in esophagus remains collapsed
-can be beneficial to confirm ETT placement during cardiac arrest

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31
Q

Hemodynamic goals w/ cardiac tamponade

A

-augment preload
-avoid hypoTN, HTN
-inotropy
-maintain HR higher (b/c limited by SV, cardiac output more dpt on HR)

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32
Q

O2 extraction following aortic cross clamping

A

decreased b/c blood not flowing to half the body -> so less O2 is utilized

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33
Q

Hemodynamic effects of aortic cross clamping

A
  1. inc arterial BP above clamp
  2. inc coronary artery BF
  3. inc LV wall stress
  4. inc CVP
  5. Inc PCWP
  6. Dec arterial BP below clamp
  7. Dec cardiac output
  8. Dec renal BF
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34
Q
A

Brugada Syndrome

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35
Q
A

Brugada syndrome
ST elevations in V1-V3
pseudo RBBB

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36
Q

tx of Brugada syndrome

A

ppx AICD

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37
Q

what lytes cause exacerbation of long QT syndrome?

A

hypoK
hypoMg
hypoCa

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38
Q

What can trigger fatal arrythmias in Brugada syndrome?

A

propofol
local anesthetics

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39
Q

Fenoldopam
-MOA
-effects
-what pt population beneficial in?

A

DA agonist
-dec in peripheral vascular resistance
-natriuresis, diuresis

-beneficial in pts undergoing TAA repairs w/ resistant HTN

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40
Q

CI to Fenoldopam

A

inc in IOP -> don’t use in pts w/ glaucoma or intraocular HTN

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41
Q

low pitched mid diastolic rumble at PMI

A

MS

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42
Q

troponin and size of MI

A

levels correlate w/ size of MI!

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43
Q

troponin and long term outcome

A

-predictive and prognostic of short and long term outcomes

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44
Q

troponin peak levels

A

24 hours

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45
Q

Myoglobin peak levels

A

4 hours

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46
Q

Inamrinone MOA

A

PDE III inhibitor -> inc cAMP levels -> inc cardiac Ca levels -> improves contractility (inotropy)
-in peripheral vasculature inc in cAMP -> vasodilation -> dec in SVR -> inc cardiac output

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47
Q

SE of inamrinone if used for longer than 24 hrs

A

thrombocytopenia

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48
Q

Digoxin and WPW

A

Digoxin is contraindicated
-the slowing of AV conduction w/ inc atrial conduction = inc conduction in accessory pathway

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49
Q

energy for sync cardioversion

A

100J

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50
Q

When are you most likely to get R on T phenomena?

A

when PM is asynchronous and pt’s HR is higher than set paced HR

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51
Q

What happens if you get R on T phenomena?

A

V tach or V fib

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52
Q

What medication predisposes pts to anaphylaxis from protamine?

A

NPH insulin

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53
Q

what causes the pulm HTN possible RV failure rxn to protamine?

A

Thromboxane
-released from plts and macrophages after stimulation by protamine-heparin complexes

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54
Q

thermodilution assessment of cardiac output: if smaller amount of injectate is used, CO will be?

A

overestimated
-b/c return to temp faster

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55
Q

thermodilution assessment of cardiac output: if injectate is warmer than programmed?

A

overestimation
-b/c won’t get as cold -> so it thinks b/c the hard moving so much

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56
Q

thermodilution assessment of cardiac output: if give a room temp bolus before assessment of cardiac output?

A

underestimate b/c all fluid colder than anticipated

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57
Q

if doing a TAVR and sudden hypoTN w/ contrast extravasation retroperitoneally what happened?

A

perforation at ilio-femoral axis

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58
Q

hypo or hyperthermia inc pulm vascular resistance?

A

hypothermia

59
Q

Recommended size of defibrillation pads

A

8-12 cm

60
Q

Factors that improve successful defibrillation

A

-adequate pad size
-gel b/w pads and pt
-biphasic debrillatoin
-quick defibrillation (faster the more likely to be successful)

61
Q

monophasic or biphasic defibrillation for V tach?

A

Biphasic: more success and can be done w/ less energy

62
Q

reverse piezoelectric effect

A

creates u/s waves during transmission

63
Q

direct piezoelectric effect

A

converts sount waves to electric current during reception

64
Q

How to assess % of PONV pt is likely to have?

A

Each RF is 20%
-female
-nonsmoker
-hx of motion sickness/hx of PONV
-gyn surgery
-young, age < 50
-opioid use

65
Q

Lidocaine and ET

A

dec duration of sz

66
Q

Obese pts and succ

A

require inc doses
-inc extracellular fluidi and inc in pseudocholinesterase

67
Q

how should NDNMB be dosed?

A

ideal body weight

68
Q

Below what age can a double lumen tube not be used?

A

12

69
Q

DL tube what view?

A

R upper lobe

70
Q

DL what view?

A

carina

71
Q

DL tube, looking at what?

A

L secondary carina w/ L upper and L lower bronchi

72
Q

Treatment of Methanol poisoning

A
  1. supportive
  2. prevent conversion of methanol to toxic metabolites (ethanol or fomepizole)
  3. severe sympm HD
73
Q

What is fomepizole used for?

A

Methanol poisoning

74
Q

What pressure is indicative of compartment syndrome?

A

> 30

75
Q

What compartment perfusion pressure is indicative of compartment syndrome?

A

< 21

76
Q

MAC care claims in ASA Closed Claims Project most common cause of litigation?

A

Death (2/2 Respiratory events)

77
Q

Lipid emulsion bolus for LAST dose

A

1.5 cc/kg for 2-3 minutes (if over 70 kg bolus 100cc)
-infuse .25 cc/kg/min

78
Q

Bone cement implantation syndrome

A

similar to fat embolism syndrome but occurs during cement implantation in OR
-hypoTN, tachycardia, resp distress

79
Q

What NT is not metabolized in lungs?

A

Dopamine, Epinephrine, Histamine

80
Q

Norepi metabolism in lungs

A

30% on first pass

81
Q

Serotonin metabolism in lungs

A

> 95% first pass

82
Q

Tourniquet pain and spinal anesthesia

A

Can still get! Especially if tourniquet is on for over an hour

83
Q

After how long w/ tourniquet do you see n and m compression injuries?

A

2 hours

84
Q

Major Diagnostic criteria for fat embolism syndrome
-require at least 1,

A

-pulm edema or resp insuff
-hypoxia
-petechial rash
-central nerve system depression

85
Q

How to diagnose fat embolism syndrome

A

-1 of major criteria (hypoxemia, resp insuff, AMS,petechial rash)
-4 minor critera (tachycardia, fever, dec hct or plts, inc ESR, retinal fat emboli, fat in urine, fat in sputum)
-fat in blood

86
Q

Hormones after brain death

A

Brain stem herniation -> ischemia, edema, and pituitary compression -> Diabetes Insipidus -> hypoTN and hyperNa
-give vasopressin to donors
-large inflammatory and catecholamine surge -> give steroids

87
Q

Goal temp for induced hypothermia for out of hospital cardiac arrest?

A

32 to 36C

88
Q

fastest way to cool someone for induced hypothermia?

A

Endovascular cooling

89
Q

when do most people die w/ induced hypothermia?

A

with too rapid rewarming

90
Q

When should cervical spine injuries be suspecteD?

A

-Other people died at scene of the accident
-fall from > 10 ft
-pelvic/long bone fx
-accident at > 35 mph
-significant closed head injury or intracranial hemorrhage
-neurological signs consistent w/ cervical spine inur

91
Q

pt gets CT w/ contrast, 4 days later gets a rash what sup?

A

delayed hypersensitivity due to T cell rxn

92
Q

Privileged conversation

A

conversation b/w 2 individuals in private and can’t be used in a court of law
-husband and wife, priest and church goer, person and their lawyer

93
Q

Why do elderly have higher initial peaks of medication conc?

A

-decreased albumin conc
-decreased volume of distribution
-dec circulation time

94
Q

Factors in Child-Pugh score

A

-bilirubin
-ascites
-encephalopathy
-INR
-albumin

95
Q

MELD score factors

A

I Crush Beer Daily
INR
Creatinie
Bilirubin
Dialysis

96
Q

spinal/epidural in ALS

A

has been shown to exacerbate dx

97
Q

best way to assess progression of ALS

A

PFTs -> more reliable of progression than musculature to understand severity of the dx

98
Q

What types of surgery should ASA be held

A

neurosurg
posterior eye
middle ear surgery
intramedullary spinal surgery (SC)
prostate surgery

99
Q

Main risks to anesthesia personnel constantly exposed to radiation

A

Cataracts
Cancer

100
Q

elderly dead space

A

increased

101
Q

elderly TV

A

no change

102
Q

elderly residual volume

A

increased

103
Q

elderly FRC

A

increased

104
Q

elderly TLC

A

unchanged

105
Q

lyte changes w/ hypothermia

A

hypoK, Mg, Phos

106
Q

U waves on EKG

A

hypoK

107
Q

hypothermia and Ca

A

hyperCa b/c lack of Na/K ATPase -> inc in Ca

108
Q

What n likely to be damaged if doing a brachial arterial line?

A

median n

109
Q

epidurals and n blocks in MS

A

no association w/ exacerbation!!

110
Q

what schedule narcotic is cocaine

A

Schedule II

111
Q

What schedule controlled substance is oxycodone?

A

Schedule II

112
Q

What schedule controlled substance is Ketamine?

A

III

113
Q

What schedule controlled substance is midazolam?

A

Schedule IV

114
Q

What schedule controlled substance is cough meds?

A

V

115
Q

BEST sensitivity to least detection of venous air embolism?

A

TEE > precordial doppler > Pulm artery catheter > EtCO2 > EKG

116
Q

Dose of Dantrolene for treatment of MH?

A

2.5 mg/kg
-can be repeated every 5-10 minutes until signs have abated

117
Q

spinal: arterial or venous vasodilation?

A

BOTH

118
Q

If extensive burns, what drugs can you give less of?

A

Midazolam (highly albumin bound)

119
Q

Which drugs do you need to give more of in burn victims?

A

hypoalbumin -> beta blockers, local anesthetics
-insulin resistance -> insulin!

120
Q

Qualifying circumstance that affects billing and payment for GA?

A

emergency
extremes of age
deliberate hypothermia
controlled hypoTN

121
Q

Dec BP but keep ICP low

A

Clevidipine
Nicardipine
Beta blockers

122
Q

Meds contraindicated when giving dantrolene

A

CCB! Verapamil, Diltazem

123
Q

what local anesthetic least likely to cross the placenta?

A

Chloroprocaine -> gets metabolized by plasma cholinesterases rapidly

124
Q

What nerve runs lateral to the biceps tendon in the antecubital fossa?

A

radial n

125
Q

Treatment of hyperMg for preeclampsia

A
  1. stop Mg
  2. give Ca
  3. give furosemide and fluids (eliminate Mg w/ loop diuretic!)
126
Q

postintubation croup cuffed v uncuffed ETTs?

A

less w/ cuffed

127
Q

why hypoTN after spinal

A

arterial and venous vasodilation
-arterial will only cause a minor dec in SVR, so doesn’t make a huge diff
-venous vasodilation -> significant diff and sign decreases preload -> hypoTN
**most of the total body volume blood lies in venous system

128
Q

How does lactulose lower ammonia in acetaminophen OD

A

prevents the ammonia from getting absorbed in the first place -> dec intestinal pH -> makes it ionized -> cant be absorbed

129
Q

If pt oliguric but taking diuretics best test to assess cause?

A

fractional excretion of urea

130
Q

Anion gap

A

Na - (Cl + lactate)

131
Q

TPN and acid base status

A

-has a large amount of Cl -> can get an anion gap metabolic acidosis

132
Q

Carbamazepine toxicity

A

-anticholinergic symp (mydriasis, no sweating)
-QT prolongation, tachycardia, hypoTN
-neuro: nystamus, AMS, delirium

133
Q

PAO2 equation

A

PAO2 = FiO2 (Patm -PH2O) - (PaCO2/0.8)

134
Q

Changes w/ heparin in pregnancy

A

-inc heparin-binding proteins
-inc renal excretion
-inc enzymes to break down heparin
-inc plasma volume

**dec bioavailability -> dosing needs to be increased

135
Q

Scleroderma and TEE

A

contraindication!

136
Q

Fent v Morphine epidural SE

A

Fent less N/V and pruritis

137
Q

qSOFA

A

RR > 22
BP systolic < 100
AMS, GCS < 15

138
Q

Anatomic landmarks for infragluteal sciatic n blocks

A

ischial tuberosity
greater trochanter of femur
sciatic groove

139
Q

SIADH labs

A

-Na < 135 (dilutional hypoNa)
-Urine osm > 100
-FeNa > 1%
-Urine Na > 20
-low serum urine acid and BUN

140
Q

which factor is assoc w/ vWD?

A

factor VIII!!!

141
Q

What’s in cryo?

A

factor VIII
vWF
factor XIII
fibrinogen

142
Q

Arytenoid dislocation symptoms

A

neck pain and strained voice, NO difficulty breathing

143
Q

early post-extubation stridor

A

laryngeal edema

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