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Flashcards in ACE 2012 9B Deck (106)
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What is naltrexone used for and what is its mechanism of action?

Alcohol or opioid dependency and is a mu, kappa, and delta receptor competitive antagonist


What do you do preoperatively for a patient taking naltrexone for alcohol dependency?

Stop it because it will hinder with pain control when you give opioids intraop (do not need to taper)


How would your opioid management change in a patient who is taking ER morphine/naltrexone pill?

No change, the naltrexone is actually behind a physical barrier in the pill (center) so that it only gets released if the patient tries to abuse it by crushing/chewing it


What does the t-test determine?

Parametric test to determine if there is a significant difference between the means of 2 groups


What does the Kaplan-Meier plot tell us?

Distinguish between the duration of survival observed among those who died and the duration of survival among those alive at the end point of the observation period (y-axis: fraction alive, x-axis: time)


What is a parametric test?

Relies on the assumption that the underlying data being tested falls in a normal distribution


What are some common side effects to gabapentin?

Sedation, peripheral edema, and weight gain (relatively safe)


What side effect do you see with bisphosphonate medications like alendronate?

Jaw necrosis


How does hyperthyroidism affect SVR, lusitropy, contractility, cardiac output?

Decreased SVR, increased lusitropy, increased contractility, increased CO


What cardiac finding do you see in almost 30% of patients with hyperthyroidism?

Atrial fibrillation (risk increases with age)


Would you see pericardial effusions with hyper- or hypothyroidism?



What would PFTs show in idiopathic pulmonary fibrosis?

Restrictive pattern (decreased FVC and FEV1, normal to increased ratio)


What do almost 85% of patients with idiopathic pulmonary fibrosis have?

Pulmonary HTN (from chronic hypoxia or hypertrophy of small pulmonary vessels)


What are the common anterior mediastinal masses?

5 T's: Thymoma, Thyroid tumor, Teratoma, Terrible lymphoma, and Thoracic aorta dilation


What is crucial with induction of GA with patients with compressive anterior mediastinal masses?

Maintenance of spontaneous ventilation (paralysis can cause collapse of airways)


What is the definition of acute kidney injury?

One of the following over less than 48 hours:
1. absolute increase in serum creatinine of 0.3 mg/dL or more
2. 50% increase in serum creatinine
3. Reduction of UOP to less than 0.5cc/kg/hr for more than 6hours


What is the traditional stimulus and response for SSEP? MEP?

SSEP: stimulus - median nerve, response - L/R scalp electrode over sensory cortex
MEP: stimulus - L/R scalp electrode over motor cortex, response - EMG in abductor pollicus brevis (APB)


Is the primary motor cortex anterior or posterior to the central sulcus? Primary sensory cortex?

Motor cortex: anterior
Sensory cortex: posterior


Do older patients require more or less hypnotic medication (i.e. propofol) and why?

Less because they have a reduced drug distribution, slower drug elimination from central compartment, and increased sensitivity to CNS depression


What is the difference between lean body weight and ideal body weight?

LBW: total body weight - weight of the fat
IBW: calculation based on sex, age and height


How should you dose propofol, fentanyl, remifentanil, succinylcholine, vecuronium, and rocuronium? Ideal body weight, total body weight, or lean body weight?

Propofol: TBW
Fentanyl: LBW
Remifentanil: LBW
Succinylcholine: TBW
Vecuronium: IBW
Rocuronium: IBW


What are the fundamental differences between a pediatric and adult airway?

1. Relatively larger tongue
2. Larynx is more cephalad (C3-C4) vs adults (C4-C5)
3. Narrow, omega-shaped epiglottis
4. Anterior angulation of vocal cords
5. Narrowest portion is at cricoid ring vs adults (glottic opening) - may or may not be true now


What is the mechanism of action for the following: clopidogrel, dabigatran, ticlopidine, tirofiban

Clopidogrel/Ticlopidine: ADP receptor antagonist
Dabigatran: direct thrombin inhibitor
Tirofiban: IIb/IIIa receptor inhibitor


What coagulation factors are involved in the intrinsic vs extrinsic pathway?

Intrinsic: XII, XI, IX, VIII
Extrinsic: VII, III (tissue factor)


What nerve is injured if you have sensory loss of the 5th finger? Wrist drop? Loss of thumb Abduction?

Ulnar nerve
Radial nerve
Median nerve


What TEE view is the best for evaluating the coronary sinus?

Midesophageal (ME) 4 chamber view and the ME 2 chamber view


What TEE view is best for evaluating wall motion abnormalities of the LV?

Transgastric (TG) mid-papillary short axis view


Does the carotid body or carotid sinus act as a baroreceptor? Which acts as a chemoreceptor?

Baroreceptor: Carotid sinus
Chemoreceptor: Carotid body


What are common nerves affected by a carotid endarterectomy?

Recurrent laryngeal, superior laryngeal, and hypoglossal nerves


If you suspect pulmonary artery rupture from PA catheter placement when coming off CPB, what is the next step?

Resume CPB
If minor hemorrhage: double-lumen tube and PEEP while weaning off CPB
If major hemorrhage: brochial blocker vs. double-lumen tube, possible lobectomy, temporary PA occlusion