Acheron: Critical Care, Infectious Disease, And Fluids Flashcards by Alyssa Rivera

Which of the following clotting factors is missing in Hemophilia B?
von Willebrand’s Factor
Factor 8
Factor 9
Factor 7
Glycoprotein 2A/3B

Factor 9

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Which of the following is seen in severe acidemia?

Agitation
Decreased cardiac response to circulating catecholamines
Hypokalemia
Hypertension
Shift of the oxyhemoglobin dissociation curve to the left

Decreased cardiac response to circulating catecholamines

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How much sodium bicarbonate should you administer if base excess is -8 and the weight of your patient is 70 kg?

84 mEq
50 mEq
12 mEq
168 mEq
75 mEq

84 mEq

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A patient has just arrived with marked hypertension. After an unsuccessful attempt using labetalol and hydralazine to control the blood pressure, the patient was put on a Nipride (nitroprusside) drip. Initially nitroprusside was able to control the blood pressure but after 48 hours the patient started to become tachycardic and tachypneic, with a rising blood pressure. An ABG reveals a blood pH of 7.30, PaO2 of 87 mmHg, and PaCO2 of 38 mmHg. The patient does not appear cyanotic. What is the most likely explanation for these physiological change?

Hypoxemia
Hyperkalemia
Acute cyanide toxicity
Hypovolemia
Synergist effect of labetalol and hydralazine

Acute cyanide toxicity

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Which of the following is the first clinically observable sign of malignant hyperthermia?

Tachycardia
Sudden rise in end tidal CO2
Sudden drop in PaO2
Dark urine (myoglobinuria)
Sudden drastic temperature increase

Sudden rise in end tidal CO2

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A 55 year old male with a history of ischemic CVA and cancer is noted on preoperative labs to have a platelet count of 65,000. He is to undergo exploratory laparotomy after having a syncopal episode at home and bruising noted on his abdominal flanks. Which of the following is least likely to lead to a decreased platelet count?

Aspirin
Hemorrhage
Leukemia
Chemotherapy
Disseminated intravascular coagulopathy

Aspirin

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What is the most prevalent extracellular buffer in the body?

Phosphate
Hemoglobin
Bicarbonate
Lactate
Ammonia

Bicarbonate

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At and above what pH value on an ABG is the patient considered alkalotic?

Blood pH greater than 7.55
Blood pH greater than 7.50
Blood pH greater than 7.45
Blood pH greater than 7.40
Blood pH greater than 7.35

Blood pH greater than 7.45

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A male patient undergoing abdominal surgery is administered ampicillin and gentamicin for bacterial pathogen coverage. The surgery is uneventful and he is administered meperidine for pain control and promethazine for nausea prior to extubation. After surgery the patient developed a gram positive infection, diagnosed by culture, and was placed on vancomycin. Other antibiotics were subsequently discontinued. Shortly after beginning the vancomycin, the patient begins to complain of difficulty hearing and has an elevated BUN and creatinine. Which of the following agents is likely to have caused this problem?

Ampicillin
Meperidine
Promethazine
Vancomycin
Gentamicin

Gentamicin

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A 32 year old male with a large left hydrocele presents for surgical incision and drainage with repair. He is allergic to penicillin which causes severe difficulty breathing, so clindamycin 900 mg is ordered. Which of the following is the mechanism of action of clindamycin?

Inhibits DNA-gyrase causing breakage of DNA strands
Binds the 50S ribosomal subunits preventing bacterial protein synthesis
Inhibits bacterial cell wall synthesis
Augments the activity of white blood cell phagocytosis
None of the above

Binds the 50S ribosomal subunits preventing bacterial protein synthesis

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Which of the following values falls in the normal range for serum bicarbonate?

5 mmol/L
25 mmol/L
35 mEq/dL
12 mg/dL
These are all normal values

25 mmol/L

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You are providing anesthesia for a patient with known pulmonary hypertension. Which of the following would be the LEAST helpful in their management?

Use of invasive hemodynamic monitoring
Preoperative dosing with sildenafil
Treatment with inhaled nitric oxide
Use of etomidate for induction
Use of milrinone to treat acute pulmonary hypertension

Use of etomidate for induction

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You are called to the emergency room to consult on a 32 year old firefighter that may have suffered smoke inhalation after a 2nd alarm commercial fire. The ER physician states he wants you to take “a second look” at the patient for your opinion on his airway condition. The firefighter states he works with a volunteer company and didn’t have time to put his breathing apparatus on before entering the structure. After entering, the room suddenly erupted into flames and he was blown through the front door. He has audible stridor which you judge as mild at this point. He admits to some trouble breathing and appears anxious. The patient just arrived in the ER and was transported from the scene immediately, making the injury timing to be within the past 15 minutes. The patient has singed nasal hair and obvious burns over his entire face and hair. What is the best course of action you recommend?

A. Give dexamethasone 8 mg IV to reduce airway swelling and place on a nasal canula.
B. Place on a non-rebreather at 15 LPM, give 125 mg of methylpredisolone and monitor closely.
C. Place on a nasal canula, give morphine for anxiety, and call for immediate transport to a burn center.
D. Monitor only, including constant pulse oximetry.
E. Preoxygenate and prepare to intubate

E. Preoxygenate and prepare to intubate

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After a very busy day in your preoperative evaluation clinic, you are down to your last five patients of the day. Your next patient is a 32 year old female who states that she suffered traumatic back injury after multiple gunshot wounds to the back 2 years ago. Would you expect autonomic hyperreflexia to be a possibility if this patient had complete cord transection at T4?

A. Yes. An injury at or above T10 can produce autonomic hyperreflexia
B. Yes. An injury at or above T6 can produce autonomic hyperreflexia
C. No. An injury at or below T8 is required to to create autonomic hyperreflexia
D. No. An injury at or below T6 is required to create autonomic hyperreflexia
E. No. Autonomic hypperreflexia is only seen in partial cord paralysis

B. Yes. An injury at or above T6 can produce autonomic hyperreflexia

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A 34 year old dialysis patient is having surgical placement of a vascular graft. A preoperative EKG shows a prolonged PR interval and occasional unifocal PVC with a heart rate of 79. During the procedure you note tall peaked T-waves followed by widening of the QRS complex and loss of the P wave as the heart rate increases to 115 with a blood pressure of 151/72. While you have multiple options to treat this condition, a treatment that you should NOT give is:

A. Insulin/Glucose
B. Calcium Gluconate
C. Kayexalate and Lasix
D. Albuterol
E. Metoprolol

E. Metoprolol

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A 75 year old male with history of coronary artery disease and myocardial infarction is undergoing transurethral resection of the prostate under spinal anesthesia with bupivicaine. 15 minutes in to the procedure the patient becomes restless. Over the next 20 minutes his blood pressure increases from 110/60 to 150/90 and his heart rate slows from 80 to 50. At this point the patient complains of difficulty breathing. The most likely cause of these symptoms is:

A. Acute myocardial infarction
B. Bupivicaine toxicity
C. Pulmonary edema
D. Hypernatremia
E. Hyperglycinemia

C. Pulmonary edema

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Which of the following is NOT found in one liter of Plasma-Lyte solution?

A. 140 mEq of sodium
B. 98 mEq of chloride
C. 5 mEq of potassium
D. 3 mEq of magnesium
E. 3 mEq of calcium

E. 3 mEq of calcium

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An 83 year old female presents for abdominal aortic aneurysm repair. She has known vascular disease and has had a myocardial infarction 3 years prior to this date. You determine her to be a candidate for invasive monitoring, and set up for arterial puncture. After placing an arterial line in the radial artery, you notice the hand has turned cyanotic and mottled. What is the next appropriate step?

A. Remove the arterial line
B. Flush the arterial line with saline
C. Administer heparin flush
D. Reposition the catheter and secure the wrist
E. Administer intraarterial nitroglycerin

A. Remove the arterial line

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Which of the following is the most likely morbid complication in rhabdomyolysis?

A. Hypernatremia
B. Hypercalcemia
C. Renal Failure
D. Muscular superinfection
E. Pancreatitis

C. Renal Failure

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Which of the following is true regarding the composition of normal saline?

A. It has an osmolality of 308
B. It contains a lactate buffer
C. It has a potassium comtent of 4 mEq
D. It has a sodium content of 308 mEq
E. It has a neutral pH

A. It has an osmolality of 308

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The PACU nurse calls you to evaluate an 83 year old patient who has just arrived in the recovery room after hip surgery. He has received 1 mg of hydromorphone along with full paralytic reversal. He was extubated after 5 seconds of sustained head lift, and transported to PACU. While initially on room air, he is noted to have slowly dropped his oxygen saturation over the past 5 minutes. His vital signs are currently HR 42, BP 89/52, SpO2 71% on room air, and respirations at 16 times a minute. The EKG shows sinus bradycardia without ectopy but with new onset ST depression noted. What is the first most immediate treatment you should administer?

A. Narcan 40 mcg
B. Oxygen at 12 LPM via nonrebreather
C. Atropine .4 mg
D. Nitroglycerine ointment
E. The patient is having an MI, consult cardiology immediately

B. Oxygen at 12 LPM via nonrebreather

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A 61 year old male with artificial heart valve replacement presents for evaluation prior to an elective TURP, scheduled next week. He states he is on an oral anticoagulant medication, but doesn’t recall the name. Which of the following tests is most likely to provide information about this patient’s coagulation status?

A. PT
B. ACT
C. D-Dimer
D. PTT
E. Platelet count

A. PT

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Which of the following would be the most common cause of post renal azotemia in a 65 year old male?

A. Prostatic hypertrophy
B. Bilateral renal calculi
C. Unilateral renal calculi
D. Bladder cancer
E. Retroperitonal fibrosis

A. Prostatic hypertrophy

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Which of the following pCO2 values on an ABG would most likely be seen with a primary metabolic acidosis?

A. 25 mmHg
B. 35 mmHg
C. 40 mmHg
D. 45 mmHg
E. 55 mmHg

A. 25 mmHg

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Which of the following disorders is most likely to cause widespread bleeding? A. Hemolytic-Uremic syndrome B. Glanzmann's thrombasthenia C. Thrombotic thrombocytopenic purpura D. Disseminated intravascular coagulation E. Idiopathic thrombocytopenic purpura

D. Disseminated intravascular coagulation

A unit of packed red blood cells has an average hematocrit of: A. 75% B. 55% C. 45% D. 65% E. 85%

A. 75%

Choose the true statement regarding Hextend versus Hespan: A. Hespan is a normal saline solution and Hextend is in lactated Ringer's B. Hextend contains potassium and sodium electrolytes C. Hespan can be administered in doses greater than one liter D. Hespan and Hextend are both in lactated Ringer's E. Hespan contains dextrose in solution where Hextend contains fructose

A. Hespan is a normal saline solution and Hextend is in lactated Ringer's

The on call neurosurgeon has ordered a teenage male patient with traumatic brain injury to the operating room for craniotomy. He tells you the patient has not yet been intubated and is currently having Biot’s respirations. Which of the following best describes “Biot’s respirations?” A. Alternating periods of tachypnea and normal breathing B. Cycles of breathing with a crescendo-decrescendo pattern of tidal volume and rate C. Cycles of rapid breathing periods followed by apnea D. Slow, shallow breaths functionally incapable of sustaining proper ventilation E. Deep, regular slow breathing

C. Cycles of rapid breathing periods followed by apnea

Which of the following best describes the renal response to acid to a metabolic acidemia? A. The kidneys will bind hydrogen to bicarbonate and excrete carbonic acid B. The kidneys will retain hydrogen ions C. The kidneys will increase ammonium ion excretion D. The kidneys will increase bicarbonate ion excretion E. The kidneys are ineffective when dealing with metabolic acidosis and compensation will be purely respiratory

C. The kidneys will increase ammonium ion excretion

A young female patient with a history of DVT is presenting for elective sinus surgery. She has not been very active lately due to depression from chronic sinusitis, and you are concerned about her history of DVT as you note mild swelling of her left calf muscle. Which of the following tests would be best to help rule out the presence of an unstable clot that could lead to pulmonary embolism? A. D-dimer B. Fibrinogen level C. Pulmonary CT angiography D. aPTT E. ACT

A. D-dimer

A 28 year old female trauma patient presents to your facility having sustained significant blood loss after a head on motor vehicle collision. She was not wearing a seatbelt and was ejected onto the highway. The surgeon provides a quick examination upon offloading from the helicopter, and determines to take her to the operating room immediately. No family has been contacted, and the patient has no medical alert bracelet, blood donor card, or other means of relating medical history to you. You are instructed by the surgeon to administer blood immediately, and with no type and screen available you determine to give her a transfusion of blood type: A. O negative B. O positive C. AB negative D. AB positive E. B negative

A. O negative

A patient having resection of his transverse, descending and sigmoid colon has just been fully opened and the surgical area exposed. If he weighs 80 kg, how much additional crystalloid should he have infused over the basal rate to compensate for the open abdominal wound: A. 560 mL/hr B. 80 mL/hr C. 160 mL/hr D. 320 mL/hr E. 800 mL/hr

A. 560 mL/hr

All of the following are to be expected in disseminated intravascular coagulation EXCEPT: A. Bleeding B. Embolism C. Renal Failure D. Thrombocytopenia E. Shortened PT and PTT intervals

E. Shortened PT and PTT intervals

A patient presents for a trans-esophageal echocardiogram. As the procedure is underway the patient becomes cyanotic and respirations decrease. You note that there does not seem to be any airway obstruction and the patient did not have a previous history of cardiac disease or pulmonary disease. A bedside ABG shows that paO2 is 90 while the pulse oximeter reads about 85%. Breath sounds are clear. What would be the most efficacious treatment? A. Methylene blue B. Dapsone C. Furosemide D. IV steroids E. Dantrolene

A. Methylene blue

After administration of heparin, which of the following tests is best to determine the clinical efficacy of anticoagulation administered to your patient? A. ACT B. aPTT C. PT/INR D. Fibrinogen level E. D-dimer

A. ACT

Which of the following is the primary immune globulin mediator in the pathogensis of anaphylaxis? A. IgA B. IgM C. IgG D. IgF E. IgE

E. IgE

Which of the following is NOT a concern with large volume transfusion of packed red blood cells? A. Citrate toxicity B. Hypocalcemia C. Metabolic acidosis D. Hypothermia E. Dilution of clotting factors

C. Metabolic acidosis

A 33 year old male patient is brought to the trauma room after being involved in a motor vehicle collision. The patient was believed to be traveling at greater than 50 miles per hour and dropped a wheel, rolling over multiple times and ejecting the unrestrained driver through the windshield. The patient is currently in a Philadelphia cervical collar and has agonal respirations. Of note he has blood coming from his right nare and you feel multiple areas of crepitus on his posterior skull. Mask ventilation with an oral airway adjunct is still being performed as EMS was unable to intubate prior to arrival. No CT scans or x-rays have been performed at this time. As you are assessing the patient, he begins to vomit. What is the best initial way to attempt intubation of this patient? A. Oral suction followed by oral intubation B. Place patient in sniffing position, suction, and use video assisted laryngoscopy C. Perform blind nasal intubation of the left nare after passing an NG tube into stomach D. Rotate the patient's neck laterally, suction, then intubate E. Continue mask ventilation and request surgery to perform a surgical airway

A. Oral suction followed by oral intubation

A 17 year old boy presenting for knee arthroscopy has a history of easy bleeding while brushing his teeth and frequent bruising despite not recalling any traumatic injury. He is sent to a hematologist who diagnosis him with Hemophilia A. Hemophilia A is a condition where the patient lacks: A. von Willebrand's Factor B. Factor 8 C. Factor 9 D. Factor 7 E. Glycoprotein IIB/IIIA

B. Factor 8

A 91 year old male presents with a cerebral hemorrhage and is taken to emergency surgery. His wife states that he has no history of stroke, heart attack, or pulmonary problems. In addition he has had previous general anesthetic for a total hip replacement without complications. He has been diagnosed with acid reflux, intention tremor, and chronic atrial fibrillation. A stat PT/INR comes back as abnormally high. What therapy may be indicated to improve this patient’s chance of survival? A. FFP B. Cryoprecipitate C. Platelets D. Leukocyte reduced whole blood E. Factor VIII

A. FFP

A 32 year old female is having an abdominal partial hysterectomy due to uterine fibroids. At the end of the case you note 150 mL of blood in the suction canister and 3 fully soaked lap pads. What is your estimated blood loss for this patient? A. 250 mL B. 300 mL C. 350 mL D. 400 mL E. 450 mL

E. 450 mL

A 62 year old female requiring left total knee arthroplasty develops urticaria when administered cefazolin. For her next surgery on the opposite knee, vancomycin is ordered as the pre-operative antibiotic. What is the mechanism of action of vancomycin and its correct bacterial coverage? A. Inhibits bacterial cell wall synthesis; Gram positive aerobic bacteria B. Inhibits bacterial DNA synthesis; Gram positive anerobic bacteria C. Inhibits bacterial cell wall synthesis; Gram negative aerobic bacteria D. Inhibits bacterial DNA synthesis; Gram positive aerobic bacteria E. Inhibits bacterial protein synthesis; Gram positive bacteria

A. Inhibits bacterial cell wall synthesis; Gram positive aerobic bacteria

A 3 year old boy is about to undergo induction for a tonsillectomy due to obstructive sleep apnea. His preoperative evaluation was otherwise negative for any health conditions and he has no known drug allergy. Though you have succinylcholine drawn up, you determine not to use it for induction because of the risk of: A. Prolonged neuromuscular blockade B. Rhabdomyolysis C. Bradycardia D. Myalgias E. Atrioventricular dissociation

B. Rhabdomyolysis

A patient about to undergo right ankle ORIF is given 1 gram of cephazolin IV in a rapid push after determining the patient has no history of allergies. Within a minute of giving the antibiotic the patient’s breathing begins to get labored, his blood pressure drops and an urticarial rash begins to develop on his chest. He also begins to complain of stomach aches and nausea and his blood pressure has dropped to 70/35. Based on this presentation, the appropriate medication for treatment is: A. Decadron 8 mg IV B. Methylprednisolone 125 mg IV C. Diphenhydramine 50 mg IV D. Epinephrine (dose dependent on IM or IV) E. Famotidine 20 mg IV

D. Epinephrine (dose dependent on IM or IV)

A definition of oliguria in adults is: A. Urine output less than 0.5 cc/kg/hr B. Urine output less than 2 cc/kg/hr C. Protein in the urine less than 100 mg/day D. Protein in the urine greater than 2 grams/day E. Urine output less than 2 liters in a 24 hour urine study

A. Urine output less than 0.5 cc/kg/hr

A 23 year old female presents for incision and drainage of a posterior back abscess. At the end of a case, you note 8 fully soaked 4×4 sponges. A fully soaked 4×4 sponge can hold how much blood? A. 5 mL B. 10 mL C. 20 mL D. 50 mL E. 100 mL

B. 10 mL

Severe hypocalcemia can cause which of the following? A. Slowed breathing rate B. Headache C. Congestive heart failure D. Sensation of euphoria E. Muscular flaccidity

C. Congestive heart failure

Which of the following is NOT a cause of an elevated anion gap metabolic acidosis? A. Elevated lactic acid levels B. Ketoacidosis C. Aspirin intoxication D. Methanol intoxication E. Renal tubular acidosis type II

E. Renal tubular acidosis type II

Which of the following is not a triggering agent for malignant hyperthermia? A. Halothane B. Nitrous Oxide C. Sevoflurane D. Desflurane E. Succinylcholine

B. Nitrous Oxide

During a laparoscopic Nissen fundoplication procedure you note that the patients airway pressures rise dramatically. You further note a fall in systolic blood pressure, and auscultation of the right lung reveals absent breath sounds and a resonant quality to percussion sounds. What is the most likely diagnosis? A. Right mainstem movement of endotracheal tube B. Traumatic pneumothorax C. Acute pneumonia D. Flash pulmonary edema E. Severe bronchospasm

B. Traumatic pneumothorax

A single liter of D5W and 1/2 normal saline contains which of the following? A. 50000 mg/dL of dextrose B. 154 mEq of sodium C. 90 mEq of sodium D. 500 mg/dL of dextrose E. 5 grams of Dextran

A. 50000 mg/dL of dextrose

A 61 year old man with a 50 pack year history of smoking presents for a video assisted thoracoscopy. He has been diagnosed with small cell lung carcinoma and SIADH. Which is a FALSE statement concerning SIADH? A. The hyponatremia seen is a result of underexcretion of water B. Patients with SIADH suffer from hypovolemia C. Serum sodium is usually low D. Hyponatremia can be worsened with administration of normal saline E. Fludrocortisone has no role in the treatment of SIADH

B. Patients with SIADH suffer from hypovolemia

A 70 kg female with a hemoglobin of 7 g/dL is given a 320 mL unit of packed red blood cells prior to heading to the operating room for a hysterectomy. An hour later another complete blood count is obtained. If the patient has lost no further blood, what will the patient’s new hemoglobin most likely be? A. 8 g/dL B. 7.5 g/dL C. 8.5 g/dL D. 7.2 g/dL E. 9 g/dL

A. 8 g/dL

A 33 year old female has a history of multiple deep venous thrombosis events and two pulmonary embolisms that have developed after minor surgeries. These events have required her hospitalization and anticoagulation. Which of the following diseases, if present in this patient, is most likely to lead to these complications? A. Factor V leiden B. Protein C excess C. Hemochromatosis D. Antithrombin III (ATIII) excess E. Christmas disease

A. Factor V leiden

Paramedics respond to an apartment complex for a welfare check after the complainant was unable to make contact with her elderly mother. The ambulance is delayed by large amounts of snow and hazardous road conditions. Upon arrival, no one comes to the door. The medics see what appears to be an adult figure on the floor and force entry. Once inside they find an 81 year old female unconscious and unresponsive on the floor, with pale white skin. Vital signs are HR 104, BP 102/74, respiratory rate 8 per minute but shallow, and SpO2 at 98% on room air. In order to best treat the underlying condition of this patient, which of the following medical therapies would be the most efficacious? A. Intubation and assisted ventilation B. Sodium thiosulfate C. Oxygen via nonrebreathing mask at 15 LPM D. Hydroxocobolamine E. Methylene blue

A. Intubation and assisted ventilation

Factor 9 is this missing factor in Hemophilia B, and is treated with administration of —, —, or —.

FFP, pooled plasma products, or factor 9.

Hemophilia B, or — disease (after a patient named Stephen Christmas who was first described as having this disease), is a clotting disorder caused by mutation of Factor IX.

Christmas

Glycoprotein IIB/IIIA is found on platelets as a receptor for fibrinogen. When bound, it aids in platelet activation, aggregation and endothelial adherence. An example is —, a drug which you may recall should be discontinued 7 days preoperatively due to increased risk of bleeding.

Abciximab

Decreased cardiac response to circulating catecholamines is seen in severe —.

acidemia

The equation to determine the amount of bicarbonate (NaHCO3) to give a person with base deficit is:

Base Deficit x Body Weight(kg) x 0.30 Only half the base deficit calculation is administered to the patient initially, so the equation is divided by 2 for primary injection.

— has given this patient cyanide toxicity.

Nitroprusside

Nitroprusside is a hypotensive agent that relaxes — smooth muscles causing the vessels to dilate.

both arteriolar and venous

As this drug is metabolized it releases nitric oxide which leads to synthesis of cGMP due to activation of guanlyly cyclase.

Nitroprusside

A sign of cyanide toxicity is when higher and higher doses of nitroprusside are required to be effective at managing —.

hypertension (tachyphylaxis)

To treat cyanide toxicity involves delivering — and administration of —.

100% O2 ; 150 mg/kg of sodium thiosulfate over 15 minutes

Hydralazine relaxes the — smooth muscles resulting in a drop of the blood pressure.

arteriolar

Sudden rise in — is the earliest sign of malignant hyperthermia.

CO2

Now with the advent of monitoring equipment, the high — seen in these patients is considered a later sign for MH.

temperatures

A sudden drop in — may be seen in conditions with decreased cardiac output, including severe pulmonary embolism, cardiac arrest, or shock.

CO2

Damage to muscle cells causes the release of intracellular contents such as — and —.

myoglobin and creatine kinase

Myoglobinuria can lead to — as the globulin precipitates and blocks the urinary tubules.

renal insufficiency

Causes of — include hemorrhage, leukemia, HELLP syndrome, DIC, and cancer chemotherapy.

thrombocytopenia

— is responsible for about 80% of extracellular buffering.

Bicarbonate

In intracellular fluid, — is a major contributing buffer.

phosphate

— is an important urinary buffer, required to produce NH4+ which is excreted through urination.

Ammonia

In patients with renal failure, lactate cannot be converted to bicarbonate and can cause a —.

lactic acidosis

Although in theory lactate is a good idea to give an acidotic patient making — a good choice.

Ringer’s Lactate

Normal blood pH is —

7.35 to 7.45

The causes of alkalosis are far more limited than the differential for acidemia and can be separated into 3 main categories:

1. volume depletion and contraction alkalosis 2. exogenous administration of bicarbonate containing substances (milk-alkali syndrome, calcium carbonate, etc) 3. loss of hydrogen and chloride ions (vomiting).

— antibiotics such as — can be ototoxic and nephrotoxic.

Aminoglycoside ; gentamicin

Generally, nephrotoxicity is seen before ototoxicity but may present independently. — and — should be monitored as should — in any patient on aminoglycosides.

BUN and creatinine ; urine output

gentamicin may — neuromuscular blockade

prolong

— binds the 50S ribosomal subunit preventing bacterial protein synthesis.

Clindamycin

Which antibiotic covers a broad spectrum of anaerobic bacteria as well as staph aureus and streptococcal bacteria. It is classically an agent of choice for anaerobic infections above the level of the diaphragm due to its tissue penetration characeristics and bacterial spectrum of coverage.

Clindamycin

Normal serum bicarbonate values are —

22-30 mmol/L

When serum bicarbonate levels drop below 22 mmol/L the patient is —.

acidotic

When greater than 30 mmol/L the patient is considered —.

alkalotic

Ketamine and Etomidate can suppress — vasodilatory actions

pulmonary

— may be the least helpful of the listed medications for acute pulmonary hypertension due to its duration of action and longer time to response after dosing.

Milrinone

— is a syndrome of massive reflex sympathetic discharge occurring in patients with spinal cord injury located above the spinal cord sympathetic outflow tract.

Autonomic dysreflexia

— should not be use on a person with hyperkalemia since it can exacerbate the cardiac effect of hyperkalemia and can also worsen symptoms of heart failure.

Metoprolol

Hyperkalemia causes skeletal muscle — due to the sustained depolarization of the membrane potential.

weakness

There are multiple treatments that can be used for hyperkalemia: 1. — increases the movement of potassium into the cell through activation of the Na/K ATPase. 2. — does not lower the level of potassium but it does improve cardiac stability during hyperkalemia and may prevent life threatening arrhythmias. 3. — is a potassium binder resin that can be given orally or as an enema. As the resin enters the large intestine, K+ is taken up into the resin in exchange for a Ca2+ or Na+. 4. — is a loop diuretic that inhibit the Na/K/2Cl symporter in the think ascending limb of the loop of Henle. Since the symporter is inhibited K+ is not taken up therefore lowering K+ serum level. 5. — that promote the uptake of potassium into the cell. 6. —, along with correcting metabolic acidosis, also promotes uptake of potassium into the cell via cellular exchange of H+for Na+ with in turn promotes the Na/K ATPase to lower serum K+.

1. Insulin 2, Calcium 3. Kayexalate (sodium or calcium polystyrene sulfonate) 4. Lasix (furosemide) 5. Albuterol beta-2 agonist 6. Sodium bicarbonate

TURP syndrome is characterized by excessive absorption of the — solutions used commonly in these procedures.

hypotonic

Note that over rapid correction of the hyponatremia may cause further morbidity through —.

Central Pontine Myelinolysis

— is not found in Plasma-lyte.

Calcium

One liter of Plasma-lyte contains — mEq sodium, — mEq chloride, — mEq potassium, and — mEq magnesium. It has a balanced pH of —, with a osmolality — mOsmol.

140 ; 98 ; 5.0 ; 3.0 ; 7.4 ; 295

Nitrogylcerin is a — dilator primarily and will have little effect on arterial circulation.

venous

— is one of the most common serious complications of rhabdomyolysis and is due to renal tubular obstruction from the circulating heme pigmented casts from the release of the intracellular muscle enzymes.

Renal failure

Normal saline has an osmolality of — mOsmol per liter and is acidic at a pH of —. Added to the water is — mEq of sodium and — mEq chloride.

308 ; 5.6 ; 154 ; 154

As PT/INR is used to measure — therapy, PT would be the single best test to order.

warfarin

The PT is used to evaluate the adequacy of the — and — pathway in the clotting chain.

“extrinsic” and common

This means it is measuring the clotting abilities of Factors —, —, —, and —.

I (fibrinogen), II (prothrombin), V, VII and X

PT values are considered normal at — seconds.

10-15

INRs of — are considered therapeutic for most situations, depending on the clinical conditions.

2.0 to 3.5

Other than coumadin therapy, hepatocellular — disease decreases production of I, II, V, VII, IX, and X in later stages and will prolong the PT.

liver

— is the most common cause of post renal azotemia in the elderly male patient.

Prostatic hypertrophy

— is an elevation of wastes including blood urea nitrogen and creatinine.

Azotemia

In a respiratory disturbance you will see the pH number and the pCO2 numbers go in — directions and for metabolic the numbers will go in the — direction.

opposite ; same

Disseminated intravascular coagulation is a disorder characterized by an excessive production of — leading to widespread intravascular coagulation.

thrombin

Glanzmanns thrombasthenia is a disorder of —.

platelet aggregation

Thrombotic thrombocytopenia purpura (TTP) and Hemolytic-Uremic syndrome (HUS) are disorders of —, but are not typically associated with bleeding unless platelet counts fall under 20,000.

platelet consumption

Idiopathic thrombocytopenic purpura (ITP) is also a disorder of —, but more benign.

platelet consumption

A single unit of packed red blood cells contains an average hematocrit of between —%.

70-80

Whereas Hespan is in —, Hextend is a — solution.

normal saline ; lactated Ringer’s

Hespan and hextend should be limited to under — liter of fluid to prevent coagulopathies.

— respirations are cycles of regular, and rapid breaths followed by apnea.

Biot’s

— respirations generally occur in response to increased intracranial pressure, brainstem herniation, or toxic metabolic encephalopathies.

Biot’s

— respirations are characterized by cycles of increasing and decreasing tidal volumes followed by apnea

Cheyne-Stokes

Slow shallow breaths as described would be characterized as “— respirations.”

agonal

The primary response in — is excretion of hydrogen ions in the urine in the form of ammonium ions (NH4) with additional acid elimination via excretion of other acid forms such as urea, creatinine, and dihydrogen-phosphate.

metabolic acidosis

The — is the best test for determining the presence of an unstable clot systemically.

D-dimer

The — is a fibrin degradation product that is made during fibrinolysis.

D-dimer

Specifically, when — breaks up a fibrin clot, fibrin degradation products and D-dimer fragments are produced.

plasmin

— test that can be used to help confirm disseminated intravascular coagulation (DIC), as well as raise the suspicion of pulmonary embolism and deep-vein thrombosis.

D-dimer

— is the universal recipient and can take any blood type if needed.

AB+

For a large open abdominal wound, an extra — mL/hr of crystalloid sollution should be added to provide for replacement of insensible losses.

6-8

— will cause the pulse oximeter to read a falsely low oxygen saturation which is usually around 85% despite a PaO2 that should read greater than 90%.

Methemoglobinemia

Methemiglobinemia results from an exposure to certain drugs, the most commonly used of which are topical anesthetic agents such as — and —, as well as medications such as — and —.

lidocaine and benzocaine ; sulfonamides and metoclopramide

— can reduce the methemoglobin back to hemoglobin and restore oxygen transport.

Methylene blue

The normal range is — seconds, and the acceptable goal for cardiac bypass surgery is at least — seconds.

150-210 ; 400

The — is preferred over aPTT for cardiac bypass surgery because it is more accurate than aPTT when high doses of heparin are used and is also less expensive and easier to perform than the aPTT.

ACT

Anaphylaxis is a disorder caused by — mediated release of histamine

IgE

— and — from mast cells and basophils.

tryptase and TNF

Histamine in large circulating concentrations is a potent — which leads to —.

vasodilator ; hypotension

Histamine can also cause coronary — leading to —.

vasoconstriction ; ischemia

Metabolic — can occur as the citrate contained with packed red blood cells is metabolized to form bicarbonate ions.

alkalosis

With a large volume transfusion care must be taken to account for dilution of — which can lead to prolonged bleeding times

clotting factors

— is used to anticoagulate blood held in storage and large amounts of it infused can lead to all of the following: — can occur from free calcium binding to available circulating citrate. — occurs as the blood is cooler than body temperature when infused.

Citrate ; Hypocalcemia ; Hypothermia

Factor 8 is the missing factor in Hemophilia A, and is treated with —, —, —, — or — replacement directly.

Pooled plasma, FFP, desmopressin, cryoprecipitate or factor VIII

Von Willebrand’s Factor is bound to Factor VIII while inactive. When activated by —, von Willebrand’s Factor releases Factor VIII and binds to exposed collagen at the injury site.

thrombin

Von Willebrand’s Factor is key to — adhesion

platelet

Factor — helps initiate the clotting cascade, and is useful in the treatment of warfarin overdose and hemorrhageic CVA.

Factor VII

FFP has many coagulation factors and can be readily used to improve this patient’s —.

PT/INR

— is most commonly used (1) for urgent reversal of warfarin therapy, (2) when PT and/or PTT are 1.5 times greater than normal, (3) for vitamin K deficiency, or (4) in deficiency of multiple coagulation factors.

FFP

Giving 10 to 15 mL/kg will raise most coagulation proteins by —%, with 5-8 mL/kg being sufficient to reverse — anticoagulation.

25-30 ; warfarin

A full soaked lap pad can hold between — mL of blood.

100-150

— inhibits bacterial cell wall synthesis, it is bacterioSTATIC in mechanism of action, not bacteriocidal.

Vancomycin

— treats infections caused by gram positive bacteria including methicillin resistant staphylococcus auereus (MRSA).

Vancomycin

— a sex-linked hereditary disorder that causes muscle fiber destruction and regeneration, resulting in progressive muscle weakness and deterioration.

Muscular dystrophy

The two most common muscular dystrophy disorders are — and —

Duchenne’s and Berker’s

— being introduced to myopathic muscles can lead to rhabdomyolysis causing hyperkalemia, leading to cardiac arrest and death in some cases.

Succinylcholine

Nondepolarizing neuromuscular relaxants can safely be given to muscular dystrophy but some patients can have — responses.

prolonged

Patients on — and — who go through anaphylaxis also have increased risks, as endogenous epinephrine is blocked from binding to their respective sites as readily. Treatment begins with removing the suspected inciting antigen.

alpha and beta blockers

— is used as a sign of renal failure and can be one of the earliest signs seen, although not all cases of acute renal failure are characterized by it.

Oliguria

In — causes, oliguria is rapidly reversible if renal perfusion and volume status is corrected in a timely manner. This is common in children who are not producing urine due to dehydration, and early rehydration can prevent renal damage.

pre-renal

— renal disease includes acute tubular necrosis. Acute tubular necrosis is due to ischemia which leads to damage to the tubular cells. In many but not all cases, this oliguria is reversible and the tubules can be repaired and regenerated.

Intrinsic

— failure is what is commonly seen due to obstruction of the outflow of urine, often due to “kidney stone” or other obstruction. This type of failure responds to treatment of the obstruction.

Postrenal

Protein in the urine greater than — grams per day is considered large proteinuria and can be seen in a variety of nephritic and nephrotic syndromes.

Nephrotic syndromes have protein in the urine greater than — grams of protein in the urine per day, whereas nephritic syndromes have smaller amounts of protein seen in the urine.

3.5

— mL can be held in a fully soaked 4×4 sponge.

— may result in muscular spasm, hyperventilation, paresthesias, diaphoresis, tetany, carpopedal spasm, torsades and myocardial depression with congestive heart failure.

Hypocalcemia

Severe hypocalcemia can manifest in a variety of ways. The symptoms will usually manifest when serum calcium levels fall below — mg/dl and are related to hyperexcitability of peripheral neurons and motor end plates.

7.5

A decrease in calcium will cause a — in the threshold potential of cells.

decrease

This decreased threshold potential will move it closer to the resting membrane potential making it easier to reach an action potential hence the —.

hyperexcitabillity

The causes of an elevated anion gap are limited in number and can be recalled via the pneumonic —.

“MUDPILES.” Methanol, Uremia, Diabetic ketoacidosis, Propylene glycol, Isoniazid, Lactic acidosis, Ethylene glycol, and Salicylates (aspirin).

The anion gap is a calculated value that represents the unmeasured anions in the serum. The equation is:

(Na+) – [(Cl-)+(HCO3-)]

The anion gap calculated resulting value represents the sum of unmeasured — in the blood. which could be causing an —.

Cations ; acidosis

Renal tubular acidosis does not cause a change in the anion gap because the etiology of the acidosis is a loss of — ion which the kidney exchanges for an equal amount of chloride ion rendering no net change in the anion gap equation.

bicarbonate

One liter of D5 1/2 NS containts — grams (— mg) dextrose.

50 ; 50,000

— is a disorder in which the body continues to secrete ADH even when Osmolality is very low (under 250 mOsm).

SIADH

SIADH treatment is primarily via — and possibly — such as conivaptan.

fluid restriction and ADH receptor antagonists

A single pack of PRBCs typically contains — mL volume at a —% hematocrit.

300 ; 75%

Factor — disorder is the most likely cause of multiple DVTs and pulmonary emboli in an otherwise healthy person of all the choices listed.

V Leiden

— disease is also known as hemophilia B, a coagulopathy.

Christmas

Protein — and — deficiency cause hypercoagulable states.

C and S

— is caused by inappropriate absorption of iron into the body which cannot be excreted. Iron is deposited into the liver and heart which can lead to heart failure and cirrhosis. Cirrhosis will lead to coagulopathies due to underproduction of clotting factors.

Hemochromatosis

Carbon monoxide binds to hemoglobin about — times more readily than oxygen, so even small concentrations of CO can cause significant problems with cellular respiration.

270

Acheron: Critical Care, Infectious Disease, And Fluids Flashcards

(178 cards)