Boardvitals Flashcards
1
Q
Benzos cause
A
Hyperpolarization of the cell membrane
2
Q
Order to act on infant if APGAR score is low
A
Stimulating
Then ventilation then
Chest compressions then
Epi
3
Q
Pre excitation of a fib give
A
Procainamide
AV nodal blockers like calcium channel or beta blockers are bad bc they prolong conduction time in AV node which could lead to Afib
4
Q
Dilation of pupils from
A
Fibers that arise from short and long ciliary nerves that originate from superior cervical ganglion
5
Q
Ziconitide MOA
A
Site of action includes dorsal horn lamina of spinal cord
6
Q
Sch 1 drug
A
Solely abuse potential with no medical use
Sch 2 is cocaine bc it has high abuse potential but has medical usage
7
Q
Larynx sits at the level of the
A
C3-C6 vertebrae
8
Q
How many sacral nerves are there
A
5
9
Q
Pin fixation systems like Mayfield clamp can lead to
A
Pressure ulcers
10
Q
Pneumoperitoneum can cause an increase in
A
SVR
11
Q
Sinus tachycardia is specific sign of
A
Myocardial contusion
12
Q
Causes of rhabdomyolysis which can show up a few days post surgery
A
Prolonged tourniquet time
Postop surgical trauma
Urine will be red to brown
13
Q
Never place a magnet on a device without
A
Knowing the effect of the maneuver
14
Q
Which blood product highest risk for bacterial contamination
A
Plts
15
Q
Botulism toxin blocks
A
Release of AcH
16
Q
Repetitive muscle exertion may temporarily correct
A
Lambert Eaton syndrome
17
Q
Opioid side effect only from parasympathetic system
A
Constipation
18
Q
In ARDS want tidal volume with decrease in plateau pressure to a goal of
A
<30
19
Q
No significant ketoacidosis is seen with HHS so
A
PH is normal whereas it is low in DKA
20
Q
PVC and red rubber tubes are
A
Flammable
21
Q
Desflurane inhalation agent of choice for
A
Chronic liver disease
22
Q
Chronic liver disease requires more induction meds due to
A
Higher Vd
23
Q
Laparoscopic surgery higher drop in
A
BP then open procedures
24
Q
Nerve conduction velocity increases with
A
Application of heat
25
Don’t do heat therapy as can increase Edema and
Bleeding acutely
26
Surfactant
Lowers surface tension
Produced by type 2 alveolar cells
Helps prevent alveolar flooding
27
AS
High LV pressure and low normal LV volume
28
Hallmark of MS is
Cerebral or spinal plaque which consists of discrete regions of axonal degeneration and myelination
29
Facet arthropathy as cause of back pain
Do diagnostic medial branch block
30
Risk factors for PDPH
```
Female
Pregnancy
Prior headaches
Younger adults
Low BMI
```
31
Artery of Adamkiewicz dermatome
T8-L1
Does anterior two thirds of spinal cord
32
Ketoconazole has
Cytochrome P450 inhibitory effects
It inhibits CYP3A4 which metabolizes lidocaine
33
Enteral nutrition max protein
1.7 g/kg/day on patients on CRRT and 0.8-1 g/kg/d in noncatabolic AKI patients without need for dialysis
34
Atropine is a
Muscarinic blocker
Can decrease sweating which can present as hyperthermia
35
Lesser occipital nerve is
Lateral to the greater occipital nerve
36
Least compensated acidosis or alkalosis in body is
Metabolic alkalosis bc pulmonary system will not hypoventilate higher than PaC02 of 55
37
Long thoracic nerve from the
Anterior Rami of C5-C7 nerve roots
38
Acute cocaine use is associated with an increase in
MAC
39
Cigarette use has no effect on
MAC value
40
Hydrocortisone has mineralocorticoid activity whereas dexamethasone does not
Causes fluid retention
41
Gold standard for measuring lung volume
Body plethysmography
42
Wall stress is proportional to
Pressure and radius and inversely proportional to thickness
43
Nerve crosses neck of fibula
Common peroneal
44
Dry cough can start after
Ace inhibitor is started
45
American College no prophylactic abx for
Diagnostic laparoscopy
Operative lap
IUD insertion
46
Half life of morphine is
Prolonged in neonates
| Immature cytochrome p450
47
Ectothiophate irreversibly inhibits
Plasma cholinesterase so don’t give succ
48
Cruzdfelt Jakob disease
Can cause EEG changes
49
Proximaltourniqyet deflated once we know the
Distal is good
50
Younger child is at lower risk for
PONV
51
Intrathecal fentanyl acts at
Substantia gelatinosa
52
Respiratory alkalosis in
Pregnancy and some compensation with bicarbonate
53
An u please vent abnormal evoked sensation
Dysthesia
54
Somatic pain
Pain carried by sensory fibers
55
Atrial pacing can’t be determined in prescience of
A fib
56
Umbilical veins brings oxygenated blood from placenta to
Fetus
Has highest oxygen content within fetal circulation
57
Mallampati 4 only see the
Hard palate
58
Mallampati type 3 see
Soft and hard palate
59
Secondary hyperparathyroidism
Low calcium
| High PTH
60
Tramadol is a
Mu opioid receptor agonist
61
DIC is associate with
Increased PT
62
SBP mainly due to
Gram negatives
Staph is very unlikely to cause it
63
Prostate bony metastasis to spine treat with
External beam radiation therapy
64
Norepinephrine offset due to
Neuronal cell reuptake
65
TFA and bromide for from hepatic transformation of
Halthone
66
Recommended ACT level prior to iniation of cardiac bypass is
480
67
ACT target for peripheral vascular surgery is
Greater then 200
68
After 500U/kg of heparin and still not high enough ACT give
FFP or antithrombin 3 complex
69
How many coccygeal spinal nerves
1
70
Ondansetron has greatest antiemetic effect if given at
End of surgery
71
Worse rhythm for long term survival
Asystole
72
Ethacrynic acid is not a
Sulfonamide whereas lasix is
73
Distal third of humerus fractures affect
Radial nerve
Affects C6-C8 and can cause wrist drop
74
Resistance is a feature of direct current
Direct
75
For regional procedures need to have
ECG from beginning to end
Can do BP every 5 minutes
76
Herpes simplex outbreak requires emergent
C section
Can usually use regional
77
What is recommended after anesthesia provider comes back after taking LOA from substance abuse
Frequent urine testing
Mainstay for monitoring
If need be, add fentanyl and propofol to drugs to check
78
Celiac plexus block main side effect
Orthostatic hypotension for 5 days
79
Increasing pulmonary pressures
As you go lower down lung
80
CPDA1 contains citrate which is an
Anticoagulant
Has shelf life of 35 days
81
Risk factors for PONV
Female sex
Non smoker, history of PONV,
Volatilevanesthetic use, nitrous use, prolonged surgery
82
Toradol half life is
5-6 hours
| Ketorolac only 3-5 days max due to decreased total body clearance and renal impairment
83
Peribulbar block involves
Injection of larger volume of local anesthetic
84
Lateral aspect of foot is innervated by
Sural nerve
85
Prolonged C02 pneumoperitoneum can lead to
Significant reduction of portal venous blood flow
86
Morphine is not metabolized by CYP2D6
Yea
87
At what level of spinal cord or higher will autonomic hyperreflexia occur
T6
88
Pathological effects of autonomic hyperreflexia
Hypertension, bradycardia, cutaneous vasoconstriction below site of lesion and cutaneous vasodilation above
89
Acute PE treatment is
LMWH
90
PE
Blood clot within pulmonary artery
Initial treatment is with LMWH
91
Radiation intensity decreases as
Inverse square of distance from radiation source
92
After transposition of the great arteries, most common cause of cyanotic heart disease in first four hours of life is
Pulmonary atresia
93
Pulmonary atresia newborns present with a
PDA
94
WideQRS
Peaked t waves think
Hyperkalemia
95
Epidural steroids or oral antivirals for
Herpes zoster although none has shown full benefits
96
Cervical spondylotic myelopathy be careful of
Neck hyper extension
97
Acromegaly is associated with
OSA
98
Acromegaly
GH is oversecreted in anterior pituitary
99
Mixed venous is checked at the
Pulmonary artery
100
In what zone is perfusion pressure equal to arterial-alveolar pressure
West zone 2
101
Blood transfusion most highlybtransmissable viral organism
Hepatitis B
102
Guidelines suggest similar fasting times for
General and regional anestgesia
103
RDDs should be worn at
Collar level or on lead apron depending on manufacturer
Don’t store RDDs next to x ray equipmrnt
104
Clonidine is known to cause a
Reflexive bradycardia
105
Hydralazine only affects
Arterioles and not the veins
106
TEE absolute contraindication
Zenker diverticulum
So is active bleeding esophageal varices
107
Intrascalene often misses the
Ulnar nerve
108
During strabismus surgery surgeon pulls at extraocular muscles causing bradycardia
The ophthalmic branch of the trigeminal nerve enters the
Gasserion ganglion
109
5 minute APGAR score of
7-10 is reassuring
110
Hetastarch has direct inhibitory effects on factor
8
111
4 Ts for HIT
Thrombocytopenia plt decreases of more then 50%
Timing, thrombosis and other causes of thrombocytopenia
The PF4/Heparin ELISA test sensitivity of nearly 100%
112
Oral morphine to tramadol conversion is
10 to 1
113
Ginkgo destroys platelets
Ginger increases intraop bleeding as well
114
Sensory innervation to oropharynx is done by CN
9
115
To do cricothyrotomy palpate
Thyroid and cricoid cartiledge and go in between
116
Don’t do cricothyrodtomy on patients less then
6
117
Hypocalcemia can lead to
Laryngospasm
118
TRALI presents as
Acute hypoxia and noncardiac pulmonary edema occurring within 6 hours of blood product transfusion
119
Awareness monitors are unreliable in patients at
Extremes of age(neonates, infants, or very elderly)
120
Procainamide can
Slow conduction across accessory pathway and potentially treat A fib
121
Most common complication of tourniquet use is
Nerve injury
122
Max dose of lido with Epi is
7 mg/kg
Without Epi is 4-5 mg/kg
Safe dose of bupivicaine or ropi is 3mg/kg
123
Pneumoperitoneum from C02 can lead to peritoneal stretching which stimulates the vagus nerve leading to
Bradycardia
Don’t give anticholinergic like glyco or atropine with pt with glaucoma
Isoprenaline a beta agonist can be used to increase HR
124
Amiodarone 300mg is
Second line for V fib if epinephrine is ineffective
125
Procainamide
Class 1a sodium channel blocker
Used for SVT
Can be associated with drug induced lupus
126
Drug induced SLE
Antihistone antibody
127
Amiodarone prolongs repolarization ad used for atrial and ventricular arrhythmias
Ocular changes and changes in skin tone have been described from amiodarone
128
Veno veno bypass for liver transplantation
Minimizes hypotension
Augments preload during vena cava clamping
129
Splanchic blood flow best preserved using
Norepinephrine
130
Vasopressin caution because of its adverse effects on
Gut perfusion
131
Most common cause of preventable birth defects in US
Alcohol
132
Drug use particularly with cocaine, heroin increases
Risk of stroke
IV heroin is associated with strokes due to septic emboli from endocarditis
133
Hydroflouric acid
Can lead to torsades de pointe
134
IV vitamin K works faster to lower INR than
Oral vitamin K
135
A practitioner wearing leader protective gear should stand on side
Containing X-ray intensifier when obtaining lateral views
136
Cervical spine X-ray not needed for
Cervical spine X-ray
137
Cardiac risk index
Include hx of stroke
138
Premature infant with retinopathy of immaturity
Anestgesia with mid of anesthetic and analgesic medications at lower doses
139
Paradoxical adduction of vocal cords on inspiration
Reassurance and breathing techniques
140
Roc is metabolized by liver
CYP450 75% and 10% by kidneys
141
Precedex leads to
Suppression of the release of norepinephrine from the presynaptic receptors at the alpha adrenergic synapse
142
Placing chest tube on right side with falling hgb is a sign of
Injury to the liver
143
Intercostal injury is
Fast bleeding and drop in hgb or it tamponades itself fast
144
NYHA classification deals with
Cardiac failure
145
Cardiac cath does not require
Endocarditis prophylaxis
146
Rebreathing can be due to
Faulty expiratory valves
147
Postconceotual age<60 weeks
No ambulatory surgery
| Also ASA3 or 4
148
Decrease distance of patient from image intensifier to lower
Radiation exposure
149
There is a physiologic tachycardia of
Pregnancy
150
If asthmatic becomes hypotensive suddenly think air trapping or auto peep
First step is to disconnect from ventilator to let trapped air escape
151
Patients become real hypotensuve when they require
Sedation
152
Morphine has
Delayed onset so not good for active labor
153
Post herpetic neuralgia
Atrophy of the dorsal horn and necrosis of the dorsal root ganglion
154
Post herpetic neuralgia first line
TCA
Usually in opthalmic portion of dorsal root ganglion
155
ESWLithotripsy is contraindicated in patients with
Bleeding disorder
156
Pregnancy is absolute contraindication to
EWSL
157
EWSL is in warm water and leads to
Vasodilation and increase in cardiac output
158
P450 CYP2D6
Breakdown codeine and oxycodone
159
Pure sensory strokes
Due to thalamus
Can cause contra lateral loss of sensation on one side of body if thalamus messed up
160
Decreased IOP from
Opioids
161
Adrenal androgen production is controlled by
ACTH
And can lead to hirsutism when in excess
162
Turbulent flow is proportional to square of
Pressure
163
What heart sound is not heard in patients with a fib
S4
Due to atrial kick against stiffened ventricle
164
Pa02=
Fi02 x patm- pC02/.8
165
Cardioversion is electric shock synchronized to the
R wave
166
Annual limit of radiation to providers should be
5 REM
167
Sickle cell trait is a relative contraindication to
Tourniquet usage
168
Nitrous oxide use
Increases uptake of volatile anesthetics and makes inhalational induction faster
169
First stage of labor pain can be treated by
Bilateral para cervical block
170
Primarily responsible for hepatic buffer response
Adenosine
171
Pregnant patients should not be offered
Food as can lead to aspiration
Can have modest fluids up to 2 hours before induction of anesthesia
172
Gas embolus
Place on 100% Fi02
Deflate abdomen
Move to left lateral and hyperventilate
173
PCI better than fibrinolytics if can get to facility within
90 min
| Load at outside facility with plavix 600mg once
174
SVR
MAP-CVP x 80/CO
175
3rd letter is
Response to sensing
176
Rate modulation should be turned off before
Proceeding to operating room by reprogramming pacemaker
177
If more cold reaches probe of pulmonary catheter then
Cardiac output will be underestimated
178
Hocm
Decreased contractility and HR is better with increased preload and Afterload
179
Work of ventricle is
Product of volume times pressure and therefore area inside a standard pressure volume loop
180
Valsalva or increased pressure on vena cava leads to
Decreased venous return
181
Inspiration augments
Venous return due to negative pressure generated in thoracic cavity
182
Early prosthetic valve endocarditis is caused by
S aureus
183
Digoxin increases myocardial contractility
Inhibition of sodium potassium ATP
184
Heparin must bind antithrombin to have
Anticoagulant effect
185
Reduced heart rate variability in
Transplanted heart
186
Major intracellular receptor of nitric oxide is
CGMP
187
Can get central venous sample from
PAC to measure mixed venous and can’t do with TEE
188
V5 lead should be placed at
Anterior axillary line fifth intercostal space
189
Don’t want MR patient to get
Bradycardia
190
Blood flow is inverse to
Length of vessel
191
Blood flow is directly proportional to
Radius to the fourth power
192
NYHA3
Marked limitation of physical activity and comfortable at rest
193
To get shoulder if no intrascalene wanted target
Axillary nerve block and suprascapular
194
Periop hypothermia in shivering patients requiring neuraxial anesthesia due to
Core to periphery heat redistribution
195
Each degree in temp down decreases metabolic rate by
6-8%
196
Spinal associated HTN in pregnant females
Phenylephrine
197
Bubble of SF6 lasts about
3 weeks in the eye
198
IV induction faster when patient has
Right to left shunt
199
Mid humerus fracture think
Radial nerve
200
Increased alVEDP is seen with
Aortic stenosis
201
Niacin need to check
Plasma Uric acid levels
202
Post pyloric stenosis surgery pts at risk for
Respiratory depression
203
Increase in mixed venous is seen with
Hypothermia
204
Serum thyroid levels do not increase in
Stress situation
Cortisol, glucagon, Epi, ADH do
205
Sotalol leads to
QT prolong
206
Retrobulbar block affects CN
2 3 5 and 6
207
Triceps reflex is
C7-C8
208
Parathyroid hormone leads to
Bone demineralization
209
PTH increases serum calcium and decreases phosphate
At most sites
210
Increase in GFR increases
Excretion of mannitol
211
Gabapentin leads to
Memory impairment and tremors
212
Pregabalin leads to
Peripheral edema
213
Carbamazepine
Ataxia, sedation, nausea, liver damage, skin rash
214
Lidocaine with Epi max dosage
7 mg/kg
215
Opioid induced constipation is via the
Peripheral nervous system alone
216
If patient with v fib are amenable to surgical or catheter ablation procedures
Should not undergo AICD placement
217
Botulism toxin
Prevents release of Ach from presynaptic nerve terminal
218
Upper again contrast study is good standard for diagnosing
Volvulus
219
Patients with deenervated hearts are super sensitive to the affects of
Adenosine
220
Infants
Large tounge
| Anterior larynx
221
Narrowest part of infant airway is at
Cricoid cartiledge
222
Iv anesthetics termination of effect is through
Redistribution
223
Definitive treatment for preeclampsia is
Give birth
224
Keep patients on beta blocker and clonidine on
Day of surgery
Don’t start beta blocker
225
Universal donor blood
O negative blood
AB positive plasma
226
Pregnant women
Decreased FRC
227
Parasympathetic NS
GI tract
SA node
Uterus
228
Norepinephrine
Sympathetic postganglionic
229
Alpha2
Inhibits norepinephrine release
230
Synethetic chatecholamines
Dobutamine
| Isoproterenol
231
Methylation by PMNT converts norepinephrine to
Epinephrine
232
Reduces death after MI
Atenolol
233
Beta 2 antagonism
Dobutamine or isoproterenol can fix
234
Glycopyrolate doesn’t cross
BBB
235
No more then
20 meQ of K
236
PR and QRS prolonged with
Hyperkalemia
237
Hyperkalemia above 6 have to treat before doing
Elective procedure
238
IO line
Proximal humerus
Proximal tibia
Distal tibia
Sternum
239
Platelets greater risk for
Bacterial contamination
240
TRALI
Non cardiogenic pulmonary edema
241
Blood transfused with CDPA-1 survives
24 hours and AS-1 42 hours
242
TRALI
Pulmonary arterial occlusion pressure<18
| Bilateral infiltrates on chest radiograph
243
No diuresis or steroids
Trali
244
D antigen
Rh positive
245
Crossmatch it mixing blood with
Donor blood to see in vitro compatability and detects more unique antibodies
246
Banked blood complications
Hyperkalemia
Hypocalcemia
Acidosis
Impaired oxygen delivery due to reduced 2-3 dpg
247
Transmucosal at base of tonsillar pillars gets
CN9
248
Laryngeal strider is a common cause of edema
Post Extubation
249
When minute ventilation greater than fresh gas flow you
Rebreath gas
250
No choloroprocaine intrathecal leads to
Adhesive arachoiditis
251
Oculocardiac reflex is CN
5 and 10
252
PH stat
Adds C02 when hypothermic during CB bypass
253
PH stat more likely
Emboli bc co2 added leads to cerebral vasodilation
254
Ischemic changes in AVM parietal lobe monitor with
Ssep and meps
255
Succ dosing
Based on TBW
256
Peribulbar is safer than retrobulbar bc far from
Vital structures
257
RA is not associated with
Bronchospasm
258
Do not reduce HR in
Cardiac tamponade
259
Coronary perfusion pressure
Aortic diastolic pressure - LV diastolic pressure
260
Carotid sinuses are
Baroceptors
Chemoceptors carotid bodies
261
First things after smoking cessation
Carboxyhemoglobin lower and shift of O2 dissociation curve to right!
262
Acidosis right shift due to
Bohr effects
263
ECT leads to increase in
ICP or CBF
264
Ecstasy leads to cardiovascular collapse
Collapse
265
Glitazones can lead to
CHF
266
IGF1 for
Acromegaly
267
No effect on inotropy or stroke volume
Diuretic
268
Milrinone with
Inotropy and vasodilation
269
Volatile anesthetics decrease
IOP
270
Hypoalbumin increases
Free fraction of benzodiazepines so lower dose required
271
NO inactivated by
Hgb
272
Don’t let venous reservoir of CPB machine go empty can lead to
Air embolus
273
Hypothermia leads to
Potentiate neuromuscular blockade
274
Can use RA as place to take
Venous blood from CPB machine
275
SSEP from dorsal column to
Post central gyrus
276
Decreases amplitude increases latency of ssep
Volatile anesthetics
277
Opioids don’t effect
SSEP
SSEP amplitude down 50% is not good or latency by 10%
278
Hypothermia increases
Latency of sseps
279
ETc02 more effective at finding venous air embolus then
ECG
280
SVR increase with
Abdominal insufflation and cardiac output and venous return down
FRC and vital capacity decreased as well
281
R on T if intrinsic above pacemaker and in
Asynchronous mode
282
FFP reduces
Dilutional coagulopathy
283
High Leak pressure replace with
Smaller tube
284
Left hepatevtomy is better than
Right and easier to do
285
Helium is
Brown and carbon dioxide is gray
286
FRC
Amount left after normal expiration
287
DLCOdecreased
Restrictive lung disease
288
Cricoid lowers
Les tone
289
Increased DLCO
CHF exercise increased blood volume increased co
290
6 hours for subq heparin
| 12 for
Sub q lovenox
291
Subglottoc secretion drainage tube and head up to prevent
Ventilator associated pneumonia
292
Bronchial hyperactivity after virus can last
6 weeks after URI
293
Normal osmolality
290
294
Lactated ringers into bicarbonate leading to
Metabolic alkalosis
295
For burn
Crystalloid
4 x kg body weight x % burn
Give half in first 8 hours
296
No tourniquet if
Sickle cell, peripheral vascular disease
297
Physostigmine for
Central nervous system problem due to scop
Crosses bbb
