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Flashcards in article reviews- Josh Deck (118):
1


ARF Postop:

what are 2 main prerenal faliure causes?

 


Diminished CO

Volume depletion

2



ARF Postop:

with prerenal cause of Diminished CO, what are some couses of the decreased Co

 

  • CHF
  • Cardiogenic shock
  • Acut MI
  • Dysrhythmia

3



ARF Postop:

with prerenal causes what causes volume depletion

 

  • hemorrhage
  • Spsis
  • GI blood/fluid loss
  • Hypoalbuminemia
  • 3rd spacing

4



ARF Postop:

what are 3 postrenal causes


ureteral obstruction

Bladder neck obstruction

Vascular obstruction

5



ARF Postop

w/ post renal failure, what causes the ureteral obstruction?>

 

  • surgical ligation
  • Papillary necrosis
  • calculi
  • Blood clot

6



ARF Postop:

w/ post renal failure what are some causes of Bladder neck obstruction?


prostate enlargement

Bladddr calculi

Urethral stricture

7



ARF Postop:

w/ post renal failure what are some causes of vascular obstruction

 

  • Renal vein thrombosis
  • Surgical ligation

8



ARF Postop:

what are 3 causes of intrarenal failure?


tubular damage

Interstitium damage

Vascular damage

9



ARF Postop:

w/ intrarenal failure what causes tubular damage?

 

  • ATN
  • Endogenous toxins
  • Exogenous toxins

10



ARF Postop:

w/ intrarenal failure what causes interstitium failure?

 

  • Drugs (abx, NSAIDS)
  • Infections

11



ARF Postop:

w/ intrarenal faliure what causes Vascular failure?


drugs

thrombotic states

12


initially  hypercalemia causes hyperexcitability of cellular membranes how?

by moving the resting membrane potential closer to the threshold potential, thus a smaller stimulus is needed to initiate a contraction

13


initially  hypercalemia causes hyperexcitability of cellular membranes by moving the resting membrane potential closer to the threshold potential, thus a smaller stimulus is needed to initiate a contraction eventually the Na-K ATPase pump begins to fatigue from excessive depolarizations, and the cellular membrane becomes what?

less excitable

14



what does hyperkalemia due to NMB induced by muscle relaxants


it potentiates the NM blockade by decreasing the excitability of the skeletal muscle

remember (
initially  hypercalemia causes hyperexcitability of cellular membranes by moving the resting membrane potential closer to the threshold potential, thus a smaller stimulus is needed to initiate a contraction eventually the Na-K ATPase pump begins to fatigue from excessive depolarizations, and the cellular membrane becomes less excitable)

15


what are major presentations of residual NM blockade?

 

  • airway obstruction
  • hypoventilation
  • hypoxemia

16


Hyperkalemia can contribult to residual what? (r/t MR)


muscle weakness

17

Hemostasis:

how is a platelet plug made?

 

  • plts activated at site of injury to form a platelet plug that provides the initial hemostatic response

18


Hemostasis:

what the primary events of Clot formation

  • exposure to tissue factor (III) at the site abd it's interaction w/ Factor VII and the Factor X (hagman factor)

19


Hemostasis:

what are the primary events for termination of clot

 

  • involves factor antithrombin, tissue factor pathway inhibtor, and protein C pathway

20


Hemostasis:

whay is there clot lysis?


restore  vessel patency

21


Hemostasis:

steps for clot lysis

 

  • plasminogen binds fibrin to tpa
  • activate proteolytic plasmin
  • cleaves fibrin, fibrinogen, and a variety of plasma proteins and clotting factors

22


what is the impairment of hemostasis and activation of fibrinolysis that occurs d/t severe injury


Acute traumatic coagulopathy (ATC)

23


ATC:

what are standard test?

 

  • PT/INR
  • aPTT
  • finrinogen level
  • plt count

24


ATC:

pt's w/o preexisting coag defects that have a prolonged PT and/ot PTT > _____ x's normal have ATC


> 1.5x's normal

25


ATC:

what type of coag monitoring is useful for monitoring ongoing resuscitation in injured pts


Thomboelastography

26


what test measure the VISOELASTIC properties of clot formation providing information on clot initiation, clot strength, and fibrinoysis


TEG

27


ATC:

what is plasma based resuscitation for a pt dx w/ ATC


PRBCs

FFP

PLT

28


ATC:

what are 3 hemostatic agents for severe coagulopathy?


Factor VIIa

Prothrombin complex concentrate

antifibrinolytic agents

29


what is a metalloprotease that cleaves vWF within developing platelet-rich thrombi to prevent hemolysis, thrombocytopenia, and tissue infarction


ADAMTS13

30


Most adult cases of ITTP are d/t acquired antibodes that inhibit what?


ADAMTS13

31


ITTP:

805 of pt's respond to what treatment?

 


plasma exchange

(removes antibody and replinishes ADAMS13)

32


ITTP:

Immunosupression w/ what drug may be as effective as salvage therapy


rituximab

33

what is teh most frequent complications that require admission r/t Sickle Cell Disease (SCD)


acute bone problems

painful vaso-occlusive crises and osteomyelitis

34


Bone Involement in SCD:

what complication startes in late infancy and continues throughout life


Vaso-occlusive crises

35



Bone Involement in SCD:

what is a complex pathogenisis that involves the activation and adhesion of Leukocytes, plts, endotheliel cells, and HgbS, can occur in any organ but most common in bone marrow?


microvascular occlusion

36



Bone Involement in SCD:

Osteolyelitis is thoought o be caused by what?


Hyposplenism

37



Bone Involement in SCD:

what bacteria is most commonly the cause of osteomyelitis list fom most to least common


Salmonella

staph A

Gram neg enteric bacilli

38



Bone Involement in SCD:

what is the most disabling chronic bone d/o


osteonecrosis

39


GERD and It's effect in DL and Intubation:

changes at the cellular level can produce ____ and subglottic ______ making the airway difficult


edema

stenosis

 

 

40


GERD and It's effect in DL and Intubation:

Hx of what should alert you to ptential abnormalities from GERD and erosion of laryngotracheal mucosa


Chronic cough

hoarseness

throat clearing

dysphagia

41


GERD and It's effect in DL and Intubation:

if GERD causes occult aspiration it can mimic what other diseases


Asthma

Bronchitis

42


GERD and It's effect in DL and Intubation:

subglottic edema seen w/ GERD can be dramatically decreased w/

preop meds

43


GERD and It's effect in DL and Intubation:

what ttype of drugs are cimetidine, Famotidine, nizatidine, rantididine?


H2 antagonist

44


GERD and It's effect in DL and Intubation:

what type of drugs are alka-selzwer, di-gel, gavison, maalox, mylanta, riopan plus, rolaids, tums


antacids

45


GERD and It's effect in DL and Intubation:

what type of drugs are cisapride, Metoclopramide?


Gastrokinetics

46


GERD and It's effect in DL and Intubation:

what type of drug is omeprazole


PPIs

47


GERD and It's effect in DL and Intubation:

combos of the previous drugs should be started at least ___ hours before anticipated GA


72

48


Genetic Nutrition: Nutritional issues in older adults:

the involuntary loss of > 5-10% of older adults usual weight during 1 year = what


increased risk for mortality

49


Genetic Nutrition: Nutritional issues in older adults:

involutary weight loss is generally r/t 1 or a combo of what 4 conditions

 

  1. inadquate dietary intake
  2. Appetite loss (anorexia)
  3. Muscle atrophy
  4. Imflammatory effects of disease

50


Genetic Nutrition: Nutritional issues in older adults:

inadequate dietary intake can be r/t what issues


social

psychospcial

medical

physiological

51


Genetic Nutrition: Nutritional issues in older adults:

what isi teh most prevelent condition that causes weight loss in the older adult


depression

52


Genetic Nutrition: Nutritional issues in older adults:

what is te 2nd most common cause of weight loss


Cancer

53


Genetic Nutrition: Nutritional issues in older adults:

sarcopenia (a degenerative loss of muscle mass) is often r/t what?


testosterone and estroge reductions

increase in insulin resistance

54


Genetic Nutrition: Nutritional issues in older adults:

if a DM pt is having issues with weight, do you place them on a diabetic diet still


fuck no, just monitor them closer

55


Genetic Nutrition: Nutritional issues in older adults:

should you treat w/ appetite stimulamnts such as megestrol and dronabinol?


nope they show no benefits

56


Genetic Nutrition: Nutritional issues in older adults:t

15% of ppl > 60 have what vit def


B12

57

Electrolyte changes.....TURP:

the study recomend checking what levels in prop for TURP pt's

 


K+

Na+

Ca++

58


Electrolyte changes.....TURP:

why o you want to optimize their electrolytes b4 sx


to prevent serious and fatal complications

59


Electrolyte changes.....TURP:

normally there is a fall of what in Na+ during a TURP?

5-8mEq/L

60


Electrolyte changes.....TURP:

procedure lasting longer than _____ min and volume of prostate gland greater than ____ could be associated w/ more complication


think 60

60 min

60 ml

61

Electrolyte changes.....TURP:

limit height of irrigation fluid column to ____cm can provide optimal vision to surgeon and reduce complications of fluid absorption


60 cm
 (23-24 inch)

i think bill stated a lower height of 16-18 inches

 

62


Electrolyte changes.....TURP:

what is a widely used irrigant, b/c of it's good optical properties, and non-electrolytic properties that prevent dissipation of diathermy current durrent resection


Glycine 1.5%

63


Electrolyte changes.....TURP:

is glycine 1.5 % hypo/hyper/or isotonic


slightly Hypotonic

64


Electrolyte changes.....TURP:

early identification of TURP syndrome and it's treatment should be based on administration of what?


hypertonic saline

65


Electrolyte changes.....TURP:

S/S of TURP syndrome CNS


restlessness

H/A

Confusion

Convulsions

Coma

Visual disturbances

N/V

66


Electrolyte changes.....TURP:

S/S TURP syndrome CV and respiratory

  • HTN
  • Tachycardia
  • Tachypnea
  • Hypoxia
  • Pulm edema
  • Hypotension
  • bradycardia

67


Electrolyte changes.....TURP:

S/S of TURP syndrome metabolic and renal


Hyponatremis

Hyperglycemia

IV hemolysis

Acute renal failure

68


Perioperative management of pt w/ liver dz:

the conerstone of periop maagement are medical treatment of liver disease complications such as what?

 

  • Coagulapathy
  • Ascites
  • Encephalopathy
  • Malnutrition

69


Perioperative management of pt w/ liver dz:

what do you want to pay close attention to post op


risk factors for infection

70


Perioperative management of pt w/ liver dz:

Sepsis, coagulopathy, and emergency sx are most strogly associated w/ what?


post op mortality

71


Perioperative management of pt w/ liver dz:

what are risk stratification systems?


CTP score

MELD score

ASA

72

Perioperative management of pt w/ liver dz:

Surgery is contraindicated if what CTP class


C

73


Perioperative management of pt w/ liver dz:

why should you use sedatives and MR w/ caution


prolonged duration of action

 

74


Perioperative management of pt w/ liver dz:

how do you want to optimize Cirrhosis pt's

 

  • correct coag (PTT w/in 3 sec of NL)
  • Goal Plt count > 50-100,000
  • Minimize ascites
  • Address nutritional status

75


Perioperative management of pt w/ liver dz:

what narc is prefered


fenatanyl

76


Perioperative management of pt w/ liver dz:

how do you treat coagulopathy

 

  • Vit K
  • FFP if Vit K ineffective
  • Cryoprecipitate
  • DDAVP if bleeding time prolonged
  • goal PT w/oin 3 sec NL

77


Perioperative management of pt w/ liver dz:

how to treat encephalopathy

 

  • Lactulose

78


Perioperative management of pt w/ liver dz:h

ow to treat ascites


Diuretics

Fluid restriction

large volume paracentesis

79

Diagnosing HIT in Cardiac surgical pts...:

Cardiac sugical pts are at increased risk for  post op HIT d/t  what factors


High dose heparin

platelet activation

CPB

80


Diagnosing HIT in Cardiac surgical pts...:h

How does HIT occur?


immune mediated response

  • teh anticoagulant causes a procoagulant effect via platelet activating antibodies that reconize multimeric platelet factoe 4 (PF4) heaprin complexes on platelet surfaces

81


Diagnosing HIT in Cardiac surgical pts...:

what are CV pt's so hard to diagnose?

b/c they have thrombocytopenia for frst 72 hours post op anyways

82


Diagnosing HIT in Cardiac surgical pts...:

prompt reconition is crucial b/c cessation of haparin and treatment w/ what reduces the risk of thromboembolic events


direct thrombin inhibitor

83


Diagnosing HIT in Cardiac surgical pts...:

what are 2 types of assays to detect HIT


Functional assays

enzyme imunoassays

84


Diagnosing HIT in Cardiac surgical pts...:

whaich assay has the highest sensitivity and specificity?


Functional assay

85


Diagnosing HIT in Cardiac surgical pts...:

why is the functional assays not used ofter?


impractical due to being very time intensive and lack of avilability

86


Diagnosing HIT in Cardiac surgical pts...:

what are 2 ex of funtional essays


HIPA (Heparin induced platelet activation assay)

SRA (serotonin release assays)

87


Diagnosing HIT in Cardiac surgical pts...:

so the enzyme immunoassays (EIA) also have a high sensitivity and rapid result but what is bad about them?


a high number of false positives

88


Airway management w/ ALL:

ALL is the most comon malignancy in who


children

89



Airway management w/ ALL:

pulmonary comlications

 

  • PNA'oulm leukostasis
  • malignant pleural effusion
  • upper airway obstrction

90



Airway management w/ ALL:

what isteh malignancy of blast cells d/t failure of cell maturation leads to accumulation of useless cells at the expense of normal hemopoietic cells


Acute leukemia

 

91



Airway management w/ ALL:

S/S


fatique

bone/joint pain

fever w/o infection

weightloss

abnormal masses

splenomegaly

leymphadenopathy

hepatomegaly

sternal tenderness

anterior mediastinal masses

petechiae/purpura

mucus membrane bleeding

fundal hemarrhage

CNS involbement

ARF

 

92



Airway management w/ ALL:

diagnosis of ALL is made how


demostration of 20% lymphoblasts in teh bone marrow

93



Airway management w/ ALL:

in kids why is there a difficult airway?


> compression of upper airway and inability of narrower lumen to accomadate edema =airway obstruction

94



Airway management w/ ALL:

what med has been used w/o abx in oropharyngeal obstruction


Dexmethasone

95


Society for ambulatory ....... Management of PONV:

can antiemetic prophylaxis eliminate PONV

nope but it can reduce it

96

Society for ambulatory ....... Management of PONV:

sorry McD but 5-HT3 receptor antagonist are more effective in prophylaxis when given when


at end of sx

97


Society for ambulatory ....... Management of PONV:

decadron is recomended at a dose of ___ at the induction to decrease PONV


4 mg

98


Society for ambulatory ....... Management of PONV:

adults at a _____ risk for PONV should receive combination therapy w/ oone or more prophylactc drugs from different classes


moderate

99


Society for ambulatory ....... Management of PONV:

when a rescue therapy is needed what type of antiemetic should be given


one from a defiierent class than used for prophylaxis

100


Society for ambulatory ....... Management of PONV:

if PONV occurs w/in ___ hours postop pts should not receive a repeat dose of prophylactic antiemetic

6 hours

101


Society for ambulatory ....... Management of PONV:

if it has been more the ____ hours an emetic episode can be treated w/ any of the g=drugs used for prophylaxis except decadron and scopolamine

6

102

Society for ambulatory ....... Management of PONV:wh

at are the pt specific risk factors

  • female
  • Nonsmoker
  • hx of PONV
  • Motion sickness

103


Society for ambulatory ....... Management of PONV:

what are anesthestic risk factors


VAAS

N2O

intrap/postop opioids

104


Society for ambulatory ....... Management of PONV:

what are surgical risk factors

 

  • Duration of sx (each 30 min increases risk by 60 %)
  • type of sx (lap, laparotomy, breast, stribismus, plastic sx, maxillofacial, gyn, abd, neuro, opthalmic, and uro)

105


Anticancer...anesthesia implications:

Chemo agents can cause ____ and _____ complications in the lungs


pneumontis and

Pulmonary fibrosis

106


Anticancer...anesthesia implications:

what is a red flag for the development of pneumonitis and pulm fibrosis


dyspnea at rest

107


Anticancer...anesthesia implications:

pt's eho had bleomycin should not receive ____ inspired O2 and _____ (a type of fluids) should be used during and after sx


high

Colloids

108


Anticancer...anesthesia implications:

____toxicity occurs w/ most anticancer drugs


hepatotoxicity

109


Anticancer...anesthesia implications:

what drug class can reduce the excretion of methotrexate


NSAIDs

110


Anticancer...anesthesia implications:

________ causes central and autonomic nervous sytem toxicity and peripheral neuropathies thus regional anesthesia is contraindicated


Vincristine

111

Renal:

the thick ascending loop gets close to the glomerulus (cortex) and cuddles next to the afferent arteriole. thsi part of the loop is called the what?

MACULA DENSA

112


Renal:

the macula densa has specialized cells and the arteriole has specialized cells and together these celles are called the what

juxtaglomerular apparatus

113


Renal:

the juxtaglomerular apparatus has an important role in the excretion of what?


renin

114


Renal:

renin secretion is stimulated by what 2 things

  1. renal hypoperfusion
  2. SNS stimulation

115


Renal:

what are the 2 major systemic effects of ATII

 

  1. systemic vasoconstriction
    • by enhancing NE release
  2. Na+ and H20 retention

116


Renal:

aldosterone is released from where?


the adrenal cortex

particulary the zona glomerulose

117


Renal:

in the collecting tubules there is 2 type of cells?

 

  1. principle cells
    • reabsorb Na+, Cl-, and secrete K+
  2. Intercalated Cells
    • secrete H+ or HCO3 and reabsrb K+

118


that is I am done there is more but I am done with flash cards for this test I am whooped

shoot me in the head