Assessments Unit 1 Flashcards
1
Q
What percentage of a diagnosis can be correctly determined from a patient history alone?
A
56%
2
Q
What constitutes a medical history exam?
A
Underlying condition requiring surgery, medical history/problems, previous surgeries/anesthetic history, anesthetic complications, ROS, current meds, allergies, tobacco/ETOH/illicit drug use, functional capacity
3
Q
What 4 things are BMI used to calculate (per powerpoint slide)?
A
1 - estimate/calculate drug dosages
2 - determine fluid volume requirement
3 - calculate acceptable blood loss
4 - adequacy of urine output
4
Q
What is important to establish from a focused physical exam?
A
The patients baseline (neuro, CV, respiratory etc) in all systems
5
Q
What acronym is used for an emergent physical exam? In an emergency if you can only pick 2, which do you pick?
A
A - allergies
M - medication
P - PMH
L - last meal
E - events leading up to surgery
Emergency pick 2 = allergies and PMH
6
Q
What accounts for almost half of perioperative mortalities?
A
Problems with the CV system
7
Q
What is a G6PD deficiency?
A
The body lacks that enzyme, which the lack of causes hemolytic anemia. RBCs break down faster than they are made in response to stress
8
Q
What court case established informed consent? Outcome of the surgery?
A
Salgo v Leland Stanford Jr. University Board of Trustees. An aortogram left the pt paralyzed
9
Q
What surgeries carry a high mortality risk (>5%)? Intermediate (1 - 5 %) or low (<1%)?
A
High = aortic and major vascular surgery
Intermediate = Intra-abdominal or intrathoracic surgery, carotid endarterectomy, head/neck surgery
Low = ambulatory, breast, endoscopic, cataract, skin, urologic, orthopedic
10
Q
What is the goal of METs?
A
greater than 4
11
Q
Define emergency, urgent and time-sensitive surgeries
A
Emergent = life or limb would be threatened if surgery did not proceed within 6 hours
Urgent = life or limb would be threatened if surgery did not proceed within 6 - 24 hours
Time-sensitive = delays exceeding 1 - 6 weeks would adversely affect patient outcomes
12
Q
What are Saklad’s 5 degrees of ASA PS grading of operative risk?
A
1 - Pt’s physical state
2 - the surgical procedure
3 - the ability/skill of the surgeon
4 - attention to post-op care
5 - past experience of the anesthetist in similar circumstances
13
Q
Define: GA, IV/monitored sedation, Regional and Local anesthesia
A
GA = total LOC, ET or LMA, major surgeries
IV/Monitored = LOC ranges, drowsy to deep sleep. NC or face mask, requires vigilant observation
Regional = numbs a large part of the body using a local anesthetic (epidural or spinal), good for child birth or a hip replacement
Local = one-time injection that numbs a small area. Such as a biopsy
14
Q
What agents most commonly have side effects in anesthesia?
A
Neuromuscular blockers, latex, antibiotics, chlorhexidine and opioids
15
Q
What medications do you continue prior to surgery?
A
HTN meds (excepts ACEs and ARBs), BBs, anti-depressants, anxiolytics, TCAs (get an EKG), thyroid meds, oral contraceptives (unless they are at high risk of thrombosis, then dc 4 weeks prior), eye drops, Gerd, opioids, anti-convulsants, asthma, corticosteroids, statins, ASA (if they had prior PCI or high grade ischemic disease) COX and MAOIs (avoid demerol and ephedrine)
16
Q
What medications do you DC prior to surgery?
A
ASA, P2Y12 (plavix, prasugrel, ticlopidine) 5-10days, topical meds (day of) diuretics (except HCTZ), sildenafil, NSAIDs, Warfarin, post-menopausal HRT, non-insulin anti-diabetics (day of), short acting insulin (if insulin pump, keep it going), long acting insulin (type 1 = take 1/3 usual dose, type 2 = take none or up to half usual dose)
17
Q
Echinacea effects?
A
Activates immune system, may decrease effectiveness of immunosuppressants and allergy concerns. No data about need to DC prior to surgery
18
Q
Ephedra effects?
A
Increase HR/BP. Increase risk of stroke/tachycardia. Long term use can cause hemodynamic instability d/t decreased catecholamines. Stop 24 hours before
19
Q
Garlic/Ginseng/Ginger/Ginkgo/Green tea effects?
A
All have change coagulation. G for bleeding. No data for ginger. Stop garlic /ginseng 7 days before, stop ginkgo 36 hours
20
Q
Kava effects?
A
sedative, anxiolytic. Stop 24 hours before
21
Q
Saw Palmetto
A
May increase bleeding risk, no data on when to stop
22
Q
St Johns wort
A
Helps with depression. Linked with delayed emergence, stop 5 days before
23
Q
Valeria
A
Sedation, may increase anesthetic requirements. No data on when to stop
24
Q
Goals of premedication aspiration prevention?
A
Less than 25 ml in the stomach and a pH greater than 2.5
25
What are the risk factors for PONV via the Apfel score? Koivuranta score?
Apfel = Female, hx of PONV, non-smoking status, post-op opioids,
Koi = Female, hx of PONV, non-smoking status, Age less than 50, duration of surgery
26
Meds that can help prevent PONV?
Scopolamine (watch for dry mouth), Lyrica (MOA unclear), Ondansetron (prevention, not treatment), Phenergan, Dexamethasone
27
Most common antibiotics and dosages?
Ancef (2-3 g, 30 mg/kg in peds, give q4h over 30 min)
Clindamycin (900 mg, 10 mg/kg in peds, give q6h over 30 - 60 min)
-for MRSA
Vancomycin (15 mg/kg in adults/peds, infuse 15 mg/min
-for MRSA
28
What should be conducted prior to administration of any mind-altering substance?
An anesthesia timeout, pt name, age, sex, hospital name, MRN, source of history and time of admission
29
What must be kept in mind regarding temperature in critically ill patients?
Core temperature will likely be different than a temporal/axillary temperature and can affect the temperature which can affect the QI measure
30
What is anthropometry?
The scientific study of the measurements and proportions of the human body
31
What areas can be used for a BP measurement?
Radial, PT/DP, brachial and popliteal. Any of these spots can be used for an arterial line too
32
What risks are involved with a rectal temperature?
Perforation, and avoid in uncooperative or immuno-suppressed patients
33
Define a pack year for a smoker
1 PPD x 365 days = 1 pack year. Anyone with 55 years or older with a 30+ PPD history = high risk lung cancer
34
What is the leading cause of beta blocker OD?
Accidental excess intake, particularly with the elderly
35
What is mediate or indirect percussion used to evaluate?
The abdomen and thorax
36
What is percussion used to evaluate for?
The presence of air or fluid in body tissues
37
What is immediate percussion used to evaluate?
The sinus or an infant thorax
38
What is fist percussion used to evaluate?
The back and kidney
39
What is circumoral cyanosis?
Blue-ish discoloration around the mouth and NOT on the lips. It is not harmful and should go away with gentle external warming
40
What are some common causes of jaundice?
Acute inflammation of the liver, inflammation or obstruction of the bile duct, hemolytic anemia, Cholestasis, and pseudo-jaundice (harmless, results from excess of beta-carotene - eating large amounts of carrot, pumpkin or melon)
41
What are some genetic causes of jaundice?
Crigler-Najjar syndrome - inherited condition that impairs an enzyme responsible for processing bilirubin
Gilberts syndrome - inherited condition that impairs the ability to excrete bile
Dubin-Johnson syndrome - inherited form of chronic jaundice that prevents conjugated bilirubin from being secreted from the cells of the liver
42
Describe the physiology of Vitiligo
An auto-immune issue where the melanocytes are attacked. Generally shows up after a triggering event like a cut, scrape or bruise
43
What are "raccoon eyes"?
Battles sign - symptom of a basilar skull fracture
44
Causes of petechiae?
Prolonged straining, medications, infectious disease, leukemia, thrombocytopenia
45
Suspect cause of unilateral edema? Bilateral?
Uni = think clot, parasite or injury
Bilat = suspect a central issue such as CHF or systemic infection
46
What is Koilonychia?
Spoon nails - sign of hypochromic anemia or iron-deficiency anemia. The nails are flat or even concave in shape.
47
What causes nail clubbing?
Generally a cardiovascular or pulmonary problem, such as lung cancer, ILD or cystic fibrosis.
48
What is Paronychia?
inflammation around the nail, usually due to a staph aureus infection or candida albicans
49
What do beau's lines indicate?
Can indicate a wide variety of issues, such as external injury, infection if its only on one nail.
Multiple nails = systemic illness (ARF, mumps, thyroid, syphilis, chemotherapy, endocarditis, melanoma, DM, pneumonia, scarlet fever, zinc deficiency)
50
What are some causes of hirsutism?
Polycystic ovary syndrome, cushing syndrome (high levels of cortisol, either an adrenal issue or too much prednisone over time), congenital adrenal hyperplasia, tumors, medications (hair growth medications, minoxidil, rogaine, androgel, testime)
51
What is ptosis?
Drooping of the eye lid
52
Ectropion vs entropion?
Ectropion = eversion, eye lid margin turned out
Entropion = inversion, lid margin turns inwards
53
What is horners syndrome?
When we paralyze a nerve supplying the eye causing miosis (pupil constriction) and a droopy eyelid (ptosis)
54
Snellen test? Random E test?
Snellen = this is the letter chart you use to assess vision
E = vision test, you use a capital E and rotate it and you have to visually identify it's position
55
Webers vs Rinnes test?
W = Tuning fork on the head and feel for vibrations
R = Tuning fork outside the ear or placed on the post-auricular bone
56
What does cherry lips, bright red skin and bright red blood indicate? Treatment?
Carbon monoxide poisoning. Tx = cyanokit
57
How to check biceps reflex?
Flex the elbow against resistance, bend arm at 90 degrees, strike the antecubital tendon and the arm should flex
58
How to check triceps reflex?
Flex the arm at the elbow, bring arm across the chest and strike the tendon behind the elbow, arm should extend
59
How to check patellar reflex?
Hammer test on the knee, make sure patient is sitting freely
60
How to check plantar relfex?
lie supine, feet relaxed and stroke the sole of their foot, the toes should flex
61
How to check gluteal reflex?
Side lying, spread the cheeks and stimulate the perineal area, sphincter should contract
62
Describe the romberg test
Checks proprioception, pt stands up, eyes closed, and see if they can maintain balance. + test = a proprioception issue
63
What 3 non-pharmacologic factors can affect a patient perception of pain?
Perceived effective communication, perceived responsiveness of the team, perceived empathy by the team
64
What makes up OPQRST pain assessment?
O = onset
P = provocation/palliation
Q = quality
R = region/radiation
S = severity
T = timing
65
How does unrelieved pain impact mortality and morbidity?
Increased oxygen demand, increased metabolic rate, higher rates of cardiovascular/pulmonary complications and reduced immune function
66
What GA anesthetic sensitizes myocardium?
Halothane
67
What GA prolongs the QT during induction?
Desflurane
68
What GA can cause bradycardia in infants?
Sevoflurane
69
Why can some LA's be dangerous if given IV? Tx?
Severe bradycardia - treat with lipid rescue
70
Why are seizure medications a concern?
Because NMBDs lose efficacy if you are on anti-seizure medications
71
What are 2 hard stops for someone with CHF?
Active chest pain/unstable angina or decompensated heart failure
72
What is the big question you need to ask asthma patients?
Have you ever had to be put on a ventilator because of your asthma
73
Why can obese patients take longer to wake up?
Volatiles and injectable sedatives can accumulate in the fat
74
What are 3 benefits of pre-op evaluation?
Anesthesia is an added risk to surgery, pre-anesthetic evaluation of patients improve clinical safety and minimizes mobility
75
What are the metric/imperial BMI formulas?
Metric = weight (Kg) / height (meters squared)
Imperial = 703 x weight (lbs) / height (inches squared)
76
Define the 3 levels of DNR orders
FC
Limited resuscitation defined with regard to specific procedure (may refuse certain resuscitation procedures, make sure pt knows which ones are essential)(try to align with patient goals)
Full DNR
77
What does a cardiac index risk of 0 through 3 indicate?
0 = 0.4% of a major cardiac event
1 = 1.0%
2 = 2.4%
3 or more = 5.4%
78
What ABX have the most common causes of anaphylaxis?
Penicillins and cephalosporins
79
What is red man syndrome?
Histamine induced redness from Vancomycin
80
What causes the allergic reaction in ester anesthetics?
The preservative PABA - para-aminobenzoic acid
81
Why would a patient report chest pain as a side effect of lidocaine administration?
Lidocaine can have epinephrine in it
82
What NMBDs have the highest rate of allergy concerns?
Quaternary ammonium compounds - Sux. Possible cross-reactivity with allergy to neostigmine and morphine
83
What test do you need to order if a patient is on a TCA?
12-ECG to check QT interval
84
What is the primary concern if a patient is on an oral contraceptive?
Post-op venous thrombosis
85
When would you continue ASA?
Continue in patients with prior PCI, high grade ischemic disease or significant cardiovascular disease
86
When would you stop a Cox-2 inhibitor?
If there are concerns about bone healing
87
What adjustments would you make if the patient was on a MAOI?
Avoid Demerol and Ephedrine
88
What is concerning if the adrenal system isn't working?
Without the appropriate hormone response, the body can't respond to hypotension as well. Start pressors earlier, maybe give hydrocortisone to help overcome the lack of cortisol
89
What dose of hydrocortisone would you give for a superficial, minor, moderate and major surgery in someone with HPA suppression?
Superficial = usual daily dose pre/post op
Minor = Hydrocortisone 50 mg IV before incision, 25 mg IV q8h for 24h
Mod = Hydrocortisone 50 mg IV before incision, 25 mg IV q8h for 24h
Major = Hydrocortisone 100 mg IV before incision, continuous 200 mg of hydrocortisone over 24 hours or 50 mg IV q8h for 24h then taper dose by 50% per day until usual daily dose reached
90
What is Mendelson syndrome?
Pneumonitis in young/healthy people who aspirated under anesthesia. This helped create the standard of regional anesthesia for most laboring women.
91
How many preventative drugs would you give with 1-2 PONV risk factors, 3-4?
1-2 = prevention with 2 - 3 drugs from different classes
3-4 = avoid GA, use propofol, minimize opiates, prevention with 3 drugs from different classes
92
What is the risk of PONV from 0 - 4 risk factors?
0 = 10%
1 = 20%
2 = 40%
3 = 60%
4 = 80%
93
What are some medications you can give to help prevent PONV?
Scopolamine, lyrica, ondansetron, phenergan, dexamethasone
94
Adjunct options for analgesia control?
NSAIDs, gabapentin, lyrica, clonidine, acetaminophen
95
What non-CV/Pulm cause does nail clubbing indicate?
If it occurs together with joint effusions/pain, then it could indicate hypertrophic osteoarthropathy
96
What is the condition where you have little or no sweating? What type of anesthesia can cause it?
Anhidrosis, and spinal anesthesia could temporarily knock that out
97
What is the first ocular reflex to be lost and when do you lose it?
Eyelash reflex and stage 2
98
What is arcus senilis?
The deposition of phospholipids and cholesterol in the cornea creating a hazy white grey or blue opaque ring around the cornea. It is benign.
99
What is retinitis pigmentosa?
Eye strokes or occlusions
100
What is papilledema?
Compressed optic nerve causing damage
101
What is a sign of optic neuritis?
Pain with ocular movement
102
Other than CO poisoning, what can cause a bright red tongue?
Iron deficiency, B12 deficiency or niacin
103
What can cause a white coating of the tongue?
Dehydration
104
What is leukoplakia?
White pre-cancerous lesions in the mouth
105
Where do you find the apical pulse?
Find the 5th ICS left of the sternum and move just medial to the left-mid clavicular line
106
Lordosis vs kyphosis?
Lordosis (think lumbar) = lumbar spine sticks forward
Kyphosis = abnormal forward curvature (think old people curve)
107
What does a + pronator drift test indicate?
Disconnect or damage between the brain and nerves communicating to the arms
108
Signs of hyperkalemia on EKG?
Wide/flat P-waves, QRS widening, tall tented T-waves
109
Hypokalemia on EKG?
ST depression and flattening of the t-wave, negative T-waves, a U-wave (wave after the T-wave)
110
Where would you expect to find a U-wave?
After the T-wave
111
Hypercalcemia on EKG?
Broad tall peaking t-waves, very wide QRS, low R wave, no p-waves, tall peaking t-waves
112
Hypocalcemia on EKG?
Narrow QRS, reduced PR, T-wave flattening/inversion, prolonged QT, prominent U-wave, ST changes
113
What does a J-wave indicate? Where would you find it?
Hypothermia and hypercalcemia. It is at the J-point (right after the QRS) and a + deflection in the precordial and limb leads, - deflection in aVR and V1
114
What is the delta wave? What is it associated with?
A slurred upstroke of the QRS, commonly associated with WPW. It is related to pre-excitation of the ventricles.
115
Where do the V leads go?
V1 = 4th ICS right of the sternum
V2 = 4th ICS left of the sternum
V3 = Between V4 and V2 (kinda 5th ICS
V4 = 5th ICS left of the sternum
V5 = 5th ICS left of the sternum but left of V4
V6 = 5th IC left of sternum left of V5
116
What is the Q-wave?
First negative deflection after the P waves, meaning the Q-wave could technically be the bottom of the QRS if there is no positive deflection
117
What is the R wave?
First positive deflection after the P wave (again, you can have a R wave without a Q-wave and vice versa)
118
What would a QS wave look like?
A QRS that never goes above isoelectric baseline, making a QS wave
119
What is the S wave?
The negative deflection below baseline after an R or Q wave
120
What is RSR prime?
It is when the QRS complex goes above isoelectric baseline twice (think 2 mountains)
121
What does RSR prime indicate?
Class pattern for a right bundle branch block in lead MCL1
122
Which is the normal axis range?
0 - 90
123
What is the physiologic left axis range?
0 to -40
124
What is a pathologic left axis range?
-40 to -90
125
What is the right axis range?
90 - 180
126
What is the difference in a physiologic and pathologic left axis shift?
Phys = a normal variant in the obese or the athletic
Path = a disease process
127
What can cause a pathological left axis shift?
Anterior hemiblock
128
What can cause a right axis shift?
Posterior hemiblock
129
What is the origin of an extreme right axis shift?
Ventricles
130
What does the LAD innervate?
Anterior wall of LV, septal wall and bundle of HIS/BB
131
What does the circumflex innervate?
Lateral wall of LV, SA/AV nodes, posterior wall of LV
132
Chest pain on exertion indicates how much occlusion?
70 - 85%
133
Chest pain at rest indicates how much occlusion?
90%
134
Chest pain unrelieved by nitro indicates how much occlusion?
100%
135
How sensitive is an EKG to an MI? why?
46 - 50%, can miss the other half due to other MIs/NSTEMI
136
What are the 3 I's of infarction?
Ischemia, Infarction and Injury pattern
137
Why are we moving away from morphine in ACS? Good option for pain?
Because morphine releases histamine = BP drops. Fentanyl a good choice instead.
138
What does a pathologic Q-wave indicate?
Q-wave greater than 40 ms wide or 1/3 the depth of R-wave. Indicates death or necrosis of tissue.
139
What non-ischemia issues can cause ST changes?
Digoxin toxicity, hypokalemia
140
Where would an inferior MI show up? Reciprocal changes? Vessel?
II, III AVF. R = I and AVL and RCA
141
Where would a septal MI show? Reciprocal? Vessel?
V1 and V2. R = II, III and AVF and LAD
142
Where would an anterior MI show? Reciprocal? Vessel?
V3/V4, R = II, III and AVF and LAD
143
Where would a lateral MI show? Reciprocal? Vessel?
V5/V6, I AVL, R = II, III and AVF. Circumflex
144
Where would a posterior MI show? Reciprocal? Vessel?
V8/V9, R > S in V1. R = V1-4 with ST depression. RCA
145
Where would a right ventricular MI show? Reciprocal? Vessel?
V4R. No reciprocal. RCA
146
What is the most common MI seen?
Inferior MI, results from occlusion of the RCA
147
What is the most lethal MI?
Anterior Wall (fed by LAD)
148
What causes ST elevation in all leads?
Pericarditis
149
Describe the basic treatment pathway for adult bradycardia
Stable vs unstable. Give atropine 1 mg, repeat q3-5 minutes up to 3 mg. If still bradycardic, start dopamine or epi, consider transcutaneous pacing
150
What are the monophasic/biphasic defibrillation values?
Mono = 360J
Bi = manufacturer recommendations, usually 120 - 200J
151
What is the dose of epi in ACLS?
1 mg q3-5 min
152
What is the dose of Amiodarone in ACLS?
First dose = 300mg, second dose = 150mg
153
What is the dose of lidocaine in ACLS?
First dose = 1 - 1.5 mg/kg, second dose = 0.5 - 0.75 mg/kg
154
In adult ACLS, which condition and when would you give amiodarone /lidocaine?
VF/VT. After epi
155
What are some of the H/T's for post arrest care?
Hypovolemia, hypoxia, hydrogen ions (acidosis), hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade, toxins, pulmonary/coronary thrombosis
156
After ROSC is obtained, what do you start if the patient is not following commands?
TTM = targeted temperature management. Goal temp 0f 32 - 36 Celsius
157
What is the adenosine dosage trend?
6 mg rapid IVP followed by 12 mg if 2nd dose is required
158
Treatment for stable regular narrow tachycardia?
Vagal, adenosine, BB or CCB, expert consultation
159
Treatment for unstable regular narrow tachycardia?
Synchronized cardioversion
160
Treatment for stable wide QRS tachycardia?
Procainamide (20 - 50 mg/min), Amiodarone 150 mg bolus followed by standard infusion, Sotalol 100 mg or 1.5 mg/kg over 5 minutes (avoid in QTC prolongation)
161
What HR do you start giving EPI to a neonate?
HR less than 60
162
Normal fetal HR?
120 - 180, anything below 100 is inadequate
163
Neonate dose of epi?
0.01 mg/kg epi
164
Rescue breathing for pediatrics if you have a pulse?
1 breath every 2-3 seconds or 20-30 breaths/minute
165
At what HR do you start CPR in peds?
HR less than 60
166
CPR compression to breath ratio in single vs dual rescue peds CPR
Single = 30 compressions to 2 breaths
Dual = 15 compressions to 2 breaths
167
What is the atropine dose in pediatrics?
0.02 mg/kg, minimum dose 0.1 mg and maximum of 0.5 mg. May repeat once.
168
What synchronized cardioversion dose do you use in pediatrics?
0.5 - 1 J/kg, up to 2 if needed
169
Adenosine dose in pediatrics?
0.1 mg/kg (max of 6) up to 0.2 mg/kg (max 12)
170
Defibrillation dose in pediatrics?
First shock = 2 J/kg, 2nd = 4 J/kg, subsequent is greater than 4 with max of 10 J/kg or adult dose
171
Pediatric Amiodarone dose?
5 mg/kg bolus, repeat up to 3 times
172
Pediatric Lidocaine dose?
1 mg/kg loading dose
173
2 most common clotting disorders in pregnancy?
Factor-5-Leiden and GP6D
174
What is a SINE wave?
A wide stretched out QRS indicative of hyperkalemia
175
Per the book answer, what does a U-wave indicate?
Hypokalemia
176
What is a fast treatment for hyperkalemia?
Give them calcium
177
What is the most common cause of hemodynamic disturbance in anesthesia?
Endotracheal intubation
178
Butterfly rashes indicate what?
Lupus
179
Clubbing of finger can indicate what (pick 4)?
VSD, overriding aorta, pulmonary stenosis an RV hypertrophy
180
Pill rolling tremors are associated with what?
Parkinsons
181
What is Murphy's sign?
RUQ pain indicating cholecystitis
182
What vision change accompanies glaucoma and meds to avoid?
Tunnel vision and anti-cholinergics (atropine, sux)
183
What is Levine's sign?
Clutching of the chest in response to an MI
184
What is Leoning's face?
Leprosy
185
What is Ludwig's angina?
Infection of the neck tissue
186
What is chipmunk face associated with?
Bulimia Nervosa
187
What is spider angioma associated with?
Liver cirrhosis
188
Pyloric stenosis is associated with what shape of mass?
Olive
189
Hyperthyroidism is associated with what ocular change?
Exopthalmus
190
What physical feature is commonly associated with Cushing syndrome?
Buffalo hump
191
Rice water stool is commonly found with what illness?
Cholera -> NS invented to treat cholera
192
What is Cullen's sign?
Bluish periumbilical discoloration associated with appendicitis
193
What is McBurney's point?
The RLQ, and rebound tenderness (more pain when pressure is released off the abdomen) here is associated with appendicitis
194
Icteric sclera is associated with what?
Hepatitis (Icteric = jaundice)
195
Addison's disease or adrenal insufficiency is associated with what color skin?
Bronze
196
What condition results in wheezing on inspiration?
Asthma
197
MG results in what facial condition?
Ptosis
198
What are 2 common findings with hyper thyroidism?
Exophthalmos and tachycardia
199
What medication must be avoided in adrenal insuffiecency?
Etomidate
200
What is Kernig's sign?
Pain or resistance to pain during extension of the knee beyond 135 degrees, indicative of meningitis
201
What is Brudzinski's sign?
Reflexive flexion of the knees/hips following passive neck flexion, indicative of meningitis
202
What is Homan's sign?
Calf pain with dorsiflexion of the feet, indicates thrombosis
203
What is Trousseau's sign?
Carpopedal spasm of the hand/wrist during a BP measurement, indicative of hypocalcemia
204
What is Chvostek's sign?
Facial twitching, indicative of hypocalcemia
205
What is the recommended lead for cardioversion?
Lead II
206
Explain how a LBBB can be a bifascicular block
The left side has the left bundle branch and the posterior hemi-fascicle, if both get blocked you can have a bi-fascicular block
207
What is the progenitor for the anterior/posterior hemifascicle?
The left bundle branch
208
What are some common causes of LV hypertrophy?
HTN, hypertrophic cardiomyopathy, extreme exercise and aortic disease.
209
What is a common cause of RV hypertrophy?
Severe lung disease, pulmonary embolus and pulmonary valve disease
210
A left/right axis deviation is associated with which hemiblocks?
L = anterior hemiblock
R = posterior hemiblock
211
Is a right axis deviation pathologic or physiologic?
Always pathologic
212
What does the RCA innervate?
Inferior/posterior wall of the LV, RV, posterior fascicle of LBB and SA/AV node
213
What is the triad to diagnose an MI?
History, physical exam and EKG, if all are +, it indicates treatment for an MI is necessary
214
What does 2 inverted T-waves indicate?
Ischemia if they are NOT in leads III and V1
215
What clinical signs suggest a RV MI?
Precipitous drop in BP following nitro administration (common to need fluids), hypotension, JVD, bradycardia, heart blocks are common, and clear lung sounds
216
Basic difference in treatment of an LV vs RV infarct
LV = nitrates and no fluid
RV = no nitrates and give fluid
217
Common s/sx of an LV infarct
VF/VT, CHB, hemiblocks
218
Why is an aortic dissection so dangerous?
It can mimic an MI and have ST elevation. This is dangerous because if you give heparin you can easily bleed out. Nitro could cause extra stress on the aorta.
219
Describe ASA physical status grading I - VI
I = healthy, non-smoking, minimal ETOH
II = Mild disease only w/o substantive functional limitations. Current smoker, social ETOH, pregnant, overweight, controlled DM/HTN
III = Severe systemic disease. Substantive functional limitation. One or more moderate/severe disease. Poor DM, COPD, HTN, obese, hepatitis, ESRD w/regular HD, moderately reduced EF
IV = Severe systemic disease that is a constant threat to life. MI, CVA, TIA, CAD/stents, severe valve dysfunction, severely reduced EF, DIC, ARDS, ESRD w/o regular HD
V = moribund pt who is not expected to survives w/o the operation. Ruptured aneurysm, massive trauma, ICH
VI = brain dead, organs being donated
220
What are the 7 anesthesia red flags?
1. bowel/bladder dysfunction
2. saddle anesthesia
3. bilateral leg weakness
4. severe, sudden onset HA
5. fever, weight loss, night sweats
6. recent injury
7. hx of cancer
221
Differentiate between myotomes and dermatomes
Myotomes – muscle groups innervated by specific spinal nerve; motor
Dermatomes - a specific area of skin that is innervated by a single spinal nerve root; sensory
222
CT vs MRI
CT - soft tissues and bones
MRI - nerves, soft tissue integrity (tendons, joints, discs)
223
What is the screening tool for OSA?
STOP-BANG (more than 3)
Snoring
Tired
Observed apnea
P - High BP
BMI > 35
Age > 50
Neck circumference > 40 cm (16 in)
Gender is male
224
What level delimits between upper and lower neck pain?
C4
225
How do you differentiate between facet and disc pain?
Facet - looking up pain
Disc - looking down pain
226
Can imaging detect osteoarthritis?
no
227
Referring pain follows ______ distribution and the neurological exam is normal
myotome
228
Radiating pain follows a _______ and is accompanied with neurological signs such as paresis, hyper-reflexia or hypoesthesia.
dermatome
229
Cauda Equina Syndrome can be caused by _______
epidurals
230
________ is a rare but serious condition that occurs when the bundle of nerves at the end of the spinal cord becomes compressed or damaged
Cauda Equina Syndrome
231
Aortic aneurysm can present as what kind of pain?
stabbing back pain
232
Shoulder pain can refer or can be referred from where?
abdomen/heart
233
SI joint vs hip pain
SI joint can't sit while hip pain can't stand
234
What is a common cause of hip replacement in young people?
avascular necrosis
235
What are the 2 congenital hip disorders?
SCFE and LCP
236
What is fluid-filled swelling called?
effusion
237
hyperextension of knee can cause what?
blood supply disturbances
