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NCE Review Material > CoreConcepts > Flashcards

CoreConcepts Flashcards

1
Q

How is GFR affected by age?

A

Decreases by 1-2% per year over 25

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2
Q

Major diagnostic criteria for Fat embolism?

A

Hypoxemia
Axillary/subconjunctival petechiae
CNS depression
Pulmonary Edema

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3
Q

What causes painless vaginal bleeding in the second and third trimester?

A

Placenta Previa

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4
Q

What is the treatment for Diabetes Insipidus?

A

DDAVP

- this is a condition where there is not enough ADH resulting in polyuria

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5
Q

What is the normal A-a Gradient based on age?

A

A-a gradient increases in the elderly

- This formula gives and estimate (Age + 4)/4

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6
Q

Half Life is directly proportional to?

A

Volume of distribution (Vd)

- Inversely to clearance

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7
Q

What is second degree AV block Type II closely associated with?

A

MI and can progress to a Complete heart block (3rd degree AV block)

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8
Q

What hemodynamic changes are usually seen with Liver Failure?

A 
Inc. CO (Hyper-dynamic state)
Low SBP (90-110)
low PaO2 (<60mmHg)
High Pulse Rates (90-100bpm)
Low SVR
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9
Q

What is the incidence of drug diversion in CRNA’s?

A

~ 10% (9-12)

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10
Q

What is the L/PSI of the O2 cylinder

A

660 L / 1900 PSI

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11
Q

What is the Flow rate and PSI of the O2 flush valve

A

Flow 35-75 L/min

60 PSI

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12
Q

Difficult airway management and intubation is associated with what congenital conditions?

A 
Treacher-collins (mandibular facial dystosis)
Pierre Robins (micrognathia & Glossoptosis)
Klippel Fleil (Cervical fusion and immobility)
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13
Q

List the phases of the capnograph and what they correlate with?

A

Phase I: Represents FGF from machine
Phase II: CO2 rich alveolar gas (deadspace)
Phase III: Expiration of gases form low V/Q areas
Phase IV: Inspiration

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14
Q

What is a common postoperative complication following carotid surgery?

A

HTN due to alterations in the carotid sinus baroreceptors

- Also CVA and MI

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15
Q

What is the target temperature for circulatory arrest in patients undergoing ascending aortic aneurysm repair?

A

15-22 degrees C for up to 25 min

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16
Q

What is the primary cause of morbidity in patients with PIH?

A

Intracerebral hemorrhage

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17
Q

How much volume is added to circulation during labor from uterine contraction?

A

300-500 mL

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18
Q

When is maternal CO the highest?

A

Immediately after delivery

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19
Q

What medication can be used to DECREASE bowel motility during abdominal surgery

A

Anticholinergics such as glycopyrolate

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20
Q

What VAA produce CO in desiccated soda lime?

A

Des > Iso&raquo_space;»> Sevo

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21
Q

What are the CV effects of abdominal insufflation

A 
Increased SVR
Atelectasis
Intrapulmonary shunting
Decreased Venous return
Decreased CO
Decreased FRC
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22
Q

How do we dose NMBs in burn patients?

A

Increased dose do to present of exntrajunctional receptors

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23
Q

What lung volumes INCREASE in the elderly patient?

A

Closing capacity

Residual Volume

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24
Q

What Lung volumes DECREASE in the elderly patient

A

Vital Capacity

Total Lung Capacity

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25
Q

Drugs to avoid in patients on MAOi’s

A

Meperidine > Ephedrine (indirect)

- may result in hyperthermia, seizures, and coma

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26
Q

What test is the best indicator of GFR?

A

Creatinine clearance

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27
Q

What is the average blood loss for tonsillectomy?

A

4 mL/kg

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28
Q

Transient blinding after a TURP is due to?

A

Glycine irrigation

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29
Q

What is the normal FRC in an adult?

A

2300

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30
Q

What is the normal Vital Capacity in an adult?

A

4500

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31
Q

What is the normal TLC in an adult?

A

5000

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32
Q

What is the normal RV in an adult?

A

1200

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33
Q

What is the normal ERV in an adult?

A

1100

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34
Q

What is the most common viral disease from blood transfusion?

A

Cytomegalovirus (CMV)

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35
Q

How to calculate EBV for adults?

A

70 mL/kg Female

75 mL/kg male

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36
Q

What cells produce surfactant

A

Type II pneumocytes

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37
Q

What factors are decreased in stored blood

A

Calcium
2,3- DPG
pH
Factor V and VIII

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38
Q

What makes chronic regional pain syndrome type II different?

A

Acute onset and follows a nerve injury

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39
Q

What is the most important factor in determining spread of LA that is injected into the subarachnoid space?

A

Baricity

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40
Q

What effect does an ETT have on deadspace?

A

Deceases deadspace by 50%

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41
Q

What effect does hypercarbia have on CBF

A

increases CBF through cerebral vasodilation

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42
Q

What are the conditions associated with Tets Of Fallot?

A

Overriding aorta
VSD (most important)
Pulmonic stenosis
RT Ventricular Hypertrophy

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43
Q

List the pediatric cervical spine anomalies.

A

“Kids Try Gold”
Klippel Fleil
Trisomy 21
Goldenhar

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44
Q

Anomalies with small underdeveloped chin?

A 
"Please Get That Chin"
Pierre Robin
Goldenhar
Treacher Collins
Cri Du Chat
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45
Q

Anomalies with big tongues

A

“Big Tongues”
Beckwith
Trisomy 21

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46
Q

What causes initial closure of the PDA?

A

A rise in arterial O2 concentration

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47
Q

Commonly used test that are used to determine causation in malpractice cases?

A

“but for” test

Substantial factor test

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48
Q

What signs are consistent with cardiogenic shock?

A

Increased PAOP (LV failure)
Low CI
Increased SVR
Venous congestion

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49
Q

NIOSH recommendations for exposure to VAA

A

VAA alone <2ppm

VAA + N2O: VAA <0.5ppm N2O<25ppm

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50
Q

The most commonly injured nerve of the lower extremity

A

The common peroneal nerve

  • Foot drop
  • loss of sensation of the dorsal aspect of the foot
  • inability to evert foot
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51
Q

Landmarks for popliteal block

A

Medial: Semimembranous ligament
Lateral: Biceps femoris
Base: crest of the posterior fossa
(Insert needs 7-10 cm above skin crease)

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52
Q

Insulin release can be stimulated via

A

Directly by glucose
Beta- stimulation (terbutaline…)
Alpha blockade (Phenoxybenzamine/phentolamine)
vagal stimulation

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53
Q

What is theophylline?

A

PDE inhibitor that causes bronchodilation d/t decrease in increase in cAMP in lungs

54
Q

Drugs that induce CYP450 system?

A

Ethanol, Barbs, ketamine, and benzos

55
Q

formula for ETT tube depth

A

12 + age/2

or 3x ett size

56
Q

Best drug for PONV in Parkinson’s patients

A

Scopolamine

57
Q

Classify fetal heart rate variability

A

Minimal: < 5 BPM
Moderate: 5-25 BPM
Marked: >25 BPM

58
Q

What are the most common cardiac abnormalities seen in Trisomy 21?

A
  • VSD

- Endocardial cushion defect (AV canal)

59
Q

What correlates with the dicrotic notch On the arterial waveform?

A

Closure of Aortic valve

- Highest flow to left coronary occurs at this time

60
Q

What cranial nerves are involved in the occulocardiac reflex?

A

Five and Dime reflex

  • Trigeminal CN V: afferent
  • Vagus CN X: efferent
61
Q

Landmarks for median nerve block of the wrist?

A

Flexor carpi radialis
Palmaris Longus tendon
Proximal crease of the wrist

62
Q

What is the dB for Alarms

A

20 dB

63
Q

What positions reduce VC?

A

Lithotomy (largest decrease), Reverse T-Burg, Supine, Prone

64
Q

VAA that causes the greatest degree of myocardial depression

A

Sevo > Des

Iso/N2O does not cause depression in CO

65
Q

The latent phase of labor is associated with

A

cervical effacement but minimal dilation

66
Q

Common electrolyte abnormality after liver is removed during liver transplant

A

Hypocalcemia d/t citrate in transfused blood not being metabolized

67
Q

The laryngeal inlet is closed by which muscles

A

Aryepiglottic muscle (opened by thyrepiglottic)

68
Q

How much N20 is in an E-Cylinder>

A

1590L (at 745 psi)

69
Q

CV manifestations of TURP syndrome?

A

(result of hypervolemia)
Bradycaria
HTN
Inc PP, CVP, PAD, PCWP

70
Q

NMB with high renal excretion

A

Pancuronium (>90%)

71
Q

How is FRC affected by pregnancy

A

It is decreased by 20%

72
Q

Why is succinylcholine dose increased in neonates and infants?

A

rapid redistribution into increase ECF volume

- increase dose up to 2x

73
Q

Safest method to secure airway with ludwigs angina

A

(a septic cellulitis of the submandibular region)

- Awake tracheostomy

74
Q

What is the SVP of the VAA

A

Des 669
Iso 238 (240)
Sevo 157

75
Q

Treatment of vasoplegic episodes in patients on ACE inhibitors that does not respond to conventional treatment?

A 
Methylene Blue (2mg/kg)
Vasopressin
76
Q

Variables measured in APGAR scoring

A 
Heart rate
Respitrations
Muscle Tone
Reflex Irritability
Color
77
Q

Where is the U wave located on the EKG and what does it signify

A

U wave present on the Wave

Hypokalemia

78
Q

Diplopia during PDPH is the result of

A

Post dural puncture headache

Traction on CN VI (Abducens n.)

79
Q

What is the most common permanent airway injury from ET intubation?

A

Dental damage

temporary is soar throat and dysphagia

80
Q

How to measure the QT interval

A

Beginning of QRS to end of T

81
Q

What is echothiophate?

A

An Irreversible cholinesterase inhibitor (Glaucoma)

- Prolongs DOA of succ (use with caution)

82
Q

What are some facts of Lamert-Eaton syndrome?

A
  • Ascending muscle weakness that improves with effort
  • weakness may involve respiratory muscles
  • Less response to anti cholinesterase agents
83
Q

What is the most common cause of hypotension in PACU?

A

Hypovolemia

84
Q

Order of systemic absorption of LA by injection site

A

Intercostal > Caudal > Epidural > Brachial plexus > Sciatic/Femoral > Sub Q

85
Q

What PONV medication can prolong Succ DOA

A

Metoclopramide due to inhibition of plasma cholinesterase activity

86
Q

Indicates increased risk of gastric aspiration

A

pH <2.5

gastric volume >25 mL

87
Q

How does CO2 rise during Apnea?

A

6 mmHg during 1st min

3-4 mmHg for each minute after

88
Q

What effect do Burn injuries have on anesthetic technique

A

NO succ after 24 hours

Higher dose of NMBs

89
Q

MOA of sulfonylureas

A

(ide)

stimulate the release of insulin from the pancreases

90
Q

What is the normal CI?

A

2.5- 4.2

91
Q

What is the most significant source of heat loss in the OR?

A

Radiation (60%) > Evaporation > Convection > Conduction

92
Q

What is the most sensitive method assessing the adequacy of cerebral perfusion in the anesthetized patient?

A

EEG monitoring

93
Q

What can cause falsely elevated values with the thermodilution method for measuring CO?

A

Pulmonic Insufficiency
VSD
ASD
TR

94
Q

O2 consumption is increase by ______ with shivering

A

up to 200%

95
Q

Risk factors for PIH

A 
primigravida (nulliparity): most significant
Extremes of ages
Multiple Births (twins)
Pre pregnancy HTN
DM
Renal Dz
Asthma
Autoimmune disease
96
Q

Common cause of decrease plasma cholinesterase activity?

A

Pregnancy

Also: alcoholism, obesity, thrombotoxicosis, ECT….

97
Q

Cauda Equina syndrome is associated with?

A

5% lidocaine
Micropore spinal catheters
The maldistribution of LA

98
Q

The only LA approved for IV regional Block

A

0.5% Lidocaine

99
Q

What facilitated closure of PDA

A

High FiO2

Indomethacin

100
Q

Drugs that can be administered wit ETT during neonatal resuscitation?

A 
"LANE"
Lido
Atropine
Nolaxone
Epinephrine
101
Q

What is the most common finding in hyperparathyroid patients with hypercalcemia?

A

Nephrolithiasis

102
Q

What current applied directly to the myocardium can induce fibrillation?

A

100 microamps (microshock)

103
Q

What generations of the respiratory system have the respiratory bronchioles?

A

17-19

104
Q

Side effects from hemabate (Carboprost)

A

Bronchoconstriction, HTN, Pulmonary vasoconstriction

105
Q

What are some mixed opioid agonist-antagonist?

A

Nalbuphine

106
Q

What is the minimum oxygen concentration at the CGO?

A

23-25%

107
Q

What are some signs and symptoms of hypoglycemia?

A 
Nervousness
Diaphoresis
mydriasis
tachycardia
HTN
108
Q

What is the largest constituent of soda lime?

A

Calcium hydroxide

109
Q

Ideal Gas law

A

1 mole of gas at STP (0 degree C and 1 atm) occupies 22.4 L

STP = standard temp and pressure

110
Q

How to reduce heat loss in the OR

A

HME filter (Evaporation)
Warm OR table (Conductive)
Warm Hot Air (Convection)

111
Q

What is the EBL for TURP

A

3-5 mL/min (usually 200-300 mL)

112
Q

What is the formula for Cerebral Perfusion Pressure

A

MAP - ICP or CVP (whichever is greater)

113
Q

How does 25% albumin affect plasma volume

A

Every 100mL increases plasma volume by 400 mL

114
Q

What is the free water deficit formula?

A

[(Na/140)-1] x (kg x 0.6)

115
Q

Spectrometry method that ionizes gas molecules and passes them through a magnetic field

A

Mass Spectometry

116
Q

What contributes to physiologic shunting?

A

Thebesian veins, bronchial veins, pleural veins

117
Q

Drugs contraindicated in patients who have Parkinson’s?

A

Droperidol

Metoclopramide

118
Q

Drug that is useful in treating tremors from Parkinson’s disease

A

Diphenhydramine (anticholinergic effect)

scopolamine

119
Q

Elderly response to hypercarbia and hypoxia

A

50% Decrease in ventilatory response too hypercarbia

- A greater decrease in response to hypoxia

120
Q

Signs of retrobulbar hemorrhage after a block?

A

dense motor block
proptosis (Bulging eye)
Palpable increase in IOP
Closing of the Lid

121
Q

Best lead for monitoring narrow complex QRS arrhythmias

A

Lead II

122
Q

How is cerebral oxygen requirement affected by temperature?

A

decreased by 6-7% for each degree C drop in temp

123
Q

What is the most common cause of heparin resistance

A

Antithrombin III deficiency

124
Q

Which alternate Hgb has little effect on pulse oximetry?

A

HgF (fetal hgb)

125
Q

What is a normal FRC in a neonate?

A

70 mL

126
Q

What is the normal RR in the neonate?

A

30-60 breaths/min

127
Q

Factors indicating postoperative respiratory ventilatory insufficiency in patients with myasthenia graves?

A 
Disease duration more that 6 years
Concomitant pulmonary disease
Negative inspiratory pressure < -25
VC < 4 mL/kg
Pyridostigmine dose > 750 mg/day
128
Q

Epidural opioid with longest DOA and most prolonged onset

A

Morphine

129
Q

Blood flow to the Liver and oxygen supply

A

O2 supply 50/50 hepatic artery and portal vein

BF is 25% hepatic artery 75% portal vein

130
Q

treatment of a patient with a carcinoid tumor includes

A

Octreotide

Volume expansion and Alpha Agonist (If hypotension)

131
Q

What are the benefits of smoking cessation

A

12-24 hours: Dec catecholamine levels, HR and BP: Also return of carboxyhemoglobin levels to normal

4-8 weeks: reduced chances of pulmonary complications

132
Q

Claims made policies

A

Only cover claims filed while the insurance is in place

NCE Review Material (8 decks)

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