CoreConcepts Flashcards
(132 cards)
1
Q
How is GFR affected by age?
A
Decreases by 1-2% per year over 25
2
Q
Major diagnostic criteria for Fat embolism?
A
Hypoxemia
Axillary/subconjunctival petechiae
CNS depression
Pulmonary Edema
3
Q
What causes painless vaginal bleeding in the second and third trimester?
A
Placenta Previa
4
Q
What is the treatment for Diabetes Insipidus?
A
DDAVP
- this is a condition where there is not enough ADH resulting in polyuria
5
Q
What is the normal A-a Gradient based on age?
A
A-a gradient increases in the elderly
- This formula gives and estimate (Age + 4)/4
6
Q
Half Life is directly proportional to?
A
Volume of distribution (Vd)
- Inversely to clearance
7
Q
What is second degree AV block Type II closely associated with?
A
MI and can progress to a Complete heart block (3rd degree AV block)
8
Q
What hemodynamic changes are usually seen with Liver Failure?
A
Inc. CO (Hyper-dynamic state) Low SBP (90-110) low PaO2 (<60mmHg) High Pulse Rates (90-100bpm) Low SVR
9
Q
What is the incidence of drug diversion in CRNA’s?
A
~ 10% (9-12)
10
Q
What is the L/PSI of the O2 cylinder
A
660 L / 1900 PSI
11
Q
What is the Flow rate and PSI of the O2 flush valve
A
Flow 35-75 L/min
60 PSI
12
Q
Difficult airway management and intubation is associated with what congenital conditions?
A
Treacher-collins (mandibular facial dystosis) Pierre Robins (micrognathia & Glossoptosis) Klippel Fleil (Cervical fusion and immobility)
13
Q
List the phases of the capnograph and what they correlate with?
A
Phase I: Represents FGF from machine
Phase II: CO2 rich alveolar gas (deadspace)
Phase III: Expiration of gases form low V/Q areas
Phase IV: Inspiration
14
Q
What is a common postoperative complication following carotid surgery?
A
HTN due to alterations in the carotid sinus baroreceptors
- Also CVA and MI
15
Q
What is the target temperature for circulatory arrest in patients undergoing ascending aortic aneurysm repair?
A
15-22 degrees C for up to 25 min
16
Q
What is the primary cause of morbidity in patients with PIH?
A
Intracerebral hemorrhage
17
Q
How much volume is added to circulation during labor from uterine contraction?
A
300-500 mL
18
Q
When is maternal CO the highest?
A
Immediately after delivery
19
Q
What medication can be used to DECREASE bowel motility during abdominal surgery
A
Anticholinergics such as glycopyrolate
20
Q
What VAA produce CO in desiccated soda lime?
A
Des > Iso»_space;»> Sevo
21
Q
What are the CV effects of abdominal insufflation
A
Increased SVR Atelectasis Intrapulmonary shunting Decreased Venous return Decreased CO Decreased FRC
22
Q
How do we dose NMBs in burn patients?
A
Increased dose do to present of exntrajunctional receptors
23
Q
What lung volumes INCREASE in the elderly patient?
A
Closing capacity
Residual Volume
24
Q
What Lung volumes DECREASE in the elderly patient
A
Vital Capacity
Total Lung Capacity
25
Drugs to avoid in patients on MAOi's
Meperidine > Ephedrine (indirect)
| - may result in hyperthermia, seizures, and coma
26
What test is the best indicator of GFR?
Creatinine clearance
27
What is the average blood loss for tonsillectomy?
4 mL/kg
28
Transient blinding after a TURP is due to?
Glycine irrigation
29
What is the normal FRC in an adult?
2300
30
What is the normal Vital Capacity in an adult?
4500
31
What is the normal TLC in an adult?
5000
32
What is the normal RV in an adult?
1200
33
What is the normal ERV in an adult?
1100
34
What is the most common viral disease from blood transfusion?
Cytomegalovirus (CMV)
35
How to calculate EBV for adults?
70 mL/kg Female
| 75 mL/kg male
36
What cells produce surfactant
Type II pneumocytes
37
What factors are decreased in stored blood
Calcium
2,3- DPG
pH
Factor V and VIII
38
What makes chronic regional pain syndrome type II different?
Acute onset and follows a nerve injury
39
What is the most important factor in determining spread of LA that is injected into the subarachnoid space?
Baricity
40
What effect does an ETT have on deadspace?
Deceases deadspace by 50%
41
What effect does hypercarbia have on CBF
increases CBF through cerebral vasodilation
42
What are the conditions associated with Tets Of Fallot?
Overriding aorta
VSD (most important)
Pulmonic stenosis
RT Ventricular Hypertrophy
43
List the pediatric cervical spine anomalies.
"Kids Try Gold"
Klippel Fleil
Trisomy 21
Goldenhar
44
Anomalies with small underdeveloped chin?
```
"Please Get That Chin"
Pierre Robin
Goldenhar
Treacher Collins
Cri Du Chat
```
45
Anomalies with big tongues
"Big Tongues"
Beckwith
Trisomy 21
46
What causes initial closure of the PDA?
A rise in arterial O2 concentration
47
Commonly used test that are used to determine causation in malpractice cases?
"but for" test
| Substantial factor test
48
What signs are consistent with cardiogenic shock?
Increased PAOP (LV failure)
Low CI
Increased SVR
Venous congestion
49
NIOSH recommendations for exposure to VAA
VAA alone <2ppm
| VAA + N2O: VAA <0.5ppm N2O<25ppm
50
The most commonly injured nerve of the lower extremity
The common peroneal nerve
- Foot drop
- loss of sensation of the dorsal aspect of the foot
- inability to evert foot
51
Landmarks for popliteal block
Medial: Semimembranous ligament
Lateral: Biceps femoris
Base: crest of the posterior fossa
(Insert needs 7-10 cm above skin crease)
52
Insulin release can be stimulated via
Directly by glucose
Beta- stimulation (terbutaline...)
Alpha blockade (Phenoxybenzamine/phentolamine)
vagal stimulation
53
What is theophylline?
PDE inhibitor that causes bronchodilation d/t decrease in increase in cAMP in lungs
54
Drugs that induce CYP450 system?
Ethanol, Barbs, ketamine, and benzos
55
formula for ETT tube depth
12 + age/2
| or 3x ett size
56
Best drug for PONV in Parkinson's patients
Scopolamine
57
Classify fetal heart rate variability
Minimal: < 5 BPM
Moderate: 5-25 BPM
Marked: >25 BPM
58
What are the most common cardiac abnormalities seen in Trisomy 21?
- VSD
| - Endocardial cushion defect (AV canal)
59
What correlates with the dicrotic notch On the arterial waveform?
Closure of Aortic valve
| - Highest flow to left coronary occurs at this time
60
What cranial nerves are involved in the occulocardiac reflex?
Five and Dime reflex
- Trigeminal CN V: afferent
- Vagus CN X: efferent
61
Landmarks for median nerve block of the wrist?
Flexor carpi radialis
Palmaris Longus tendon
Proximal crease of the wrist
62
What is the dB for Alarms
20 dB
63
What positions reduce VC?
Lithotomy (largest decrease), Reverse T-Burg, Supine, Prone
64
VAA that causes the greatest degree of myocardial depression
Sevo > Des
| Iso/N2O does not cause depression in CO
65
The latent phase of labor is associated with
cervical effacement but minimal dilation
66
Common electrolyte abnormality after liver is removed during liver transplant
Hypocalcemia d/t citrate in transfused blood not being metabolized
67
The laryngeal inlet is closed by which muscles
Aryepiglottic muscle (opened by thyrepiglottic)
68
How much N20 is in an E-Cylinder>
1590L (at 745 psi)
69
CV manifestations of TURP syndrome?
(result of hypervolemia)
Bradycaria
HTN
Inc PP, CVP, PAD, PCWP
70
NMB with high renal excretion
Pancuronium (>90%)
71
How is FRC affected by pregnancy
It is decreased by 20%
72
Why is succinylcholine dose increased in neonates and infants?
rapid redistribution into increase ECF volume
| - increase dose up to 2x
73
Safest method to secure airway with ludwigs angina
(a septic cellulitis of the submandibular region)
| - Awake tracheostomy
74
What is the SVP of the VAA
Des 669
Iso 238 (240)
Sevo 157
75
Treatment of vasoplegic episodes in patients on ACE inhibitors that does not respond to conventional treatment?
```
Methylene Blue (2mg/kg)
Vasopressin
```
76
Variables measured in APGAR scoring
```
Heart rate
Respitrations
Muscle Tone
Reflex Irritability
Color
```
77
Where is the U wave located on the EKG and what does it signify
U wave present on the Wave
| Hypokalemia
78
Diplopia during PDPH is the result of
Post dural puncture headache
Traction on CN VI (Abducens n.)
79
What is the most common permanent airway injury from ET intubation?
Dental damage
| temporary is soar throat and dysphagia
80
How to measure the QT interval
Beginning of QRS to end of T
81
What is echothiophate?
An Irreversible cholinesterase inhibitor (Glaucoma)
| - Prolongs DOA of succ (use with caution)
82
What are some facts of Lamert-Eaton syndrome?
- Ascending muscle weakness that improves with effort
- weakness may involve respiratory muscles
- Less response to anti cholinesterase agents
83
What is the most common cause of hypotension in PACU?
Hypovolemia
84
Order of systemic absorption of LA by injection site
Intercostal > Caudal > Epidural > Brachial plexus > Sciatic/Femoral > Sub Q
85
What PONV medication can prolong Succ DOA
Metoclopramide due to inhibition of plasma cholinesterase activity
86
Indicates increased risk of gastric aspiration
pH <2.5
| gastric volume >25 mL
87
How does CO2 rise during Apnea?
6 mmHg during 1st min
| 3-4 mmHg for each minute after
88
What effect do Burn injuries have on anesthetic technique
NO succ after 24 hours
| Higher dose of NMBs
89
MOA of sulfonylureas
(ide)
| stimulate the release of insulin from the pancreases
90
What is the normal CI?
2.5- 4.2
91
What is the most significant source of heat loss in the OR?
Radiation (60%) > Evaporation > Convection > Conduction
92
What is the most sensitive method assessing the adequacy of cerebral perfusion in the anesthetized patient?
EEG monitoring
93
What can cause falsely elevated values with the thermodilution method for measuring CO?
Pulmonic Insufficiency
VSD
ASD
TR
94
O2 consumption is increase by ______ with shivering
up to 200%
95
Risk factors for PIH
```
primigravida (nulliparity): most significant
Extremes of ages
Multiple Births (twins)
Pre pregnancy HTN
DM
Renal Dz
Asthma
Autoimmune disease
```
96
Common cause of decrease plasma cholinesterase activity?
Pregnancy
| Also: alcoholism, obesity, thrombotoxicosis, ECT....
97
Cauda Equina syndrome is associated with?
5% lidocaine
Micropore spinal catheters
The maldistribution of LA
98
The only LA approved for IV regional Block
0.5% Lidocaine
99
What facilitated closure of PDA
High FiO2
| Indomethacin
100
Drugs that can be administered wit ETT during neonatal resuscitation?
```
"LANE"
Lido
Atropine
Nolaxone
Epinephrine
```
101
What is the most common finding in hyperparathyroid patients with hypercalcemia?
Nephrolithiasis
102
What current applied directly to the myocardium can induce fibrillation?
100 microamps (microshock)
103
What generations of the respiratory system have the respiratory bronchioles?
17-19
104
Side effects from hemabate (Carboprost)
Bronchoconstriction, HTN, Pulmonary vasoconstriction
105
What are some mixed opioid agonist-antagonist?
Nalbuphine
106
What is the minimum oxygen concentration at the CGO?
23-25%
107
What are some signs and symptoms of hypoglycemia?
```
Nervousness
Diaphoresis
mydriasis
tachycardia
HTN
```
108
What is the largest constituent of soda lime?
Calcium hydroxide
109
Ideal Gas law
1 mole of gas at STP (0 degree C and 1 atm) occupies 22.4 L
STP = standard temp and pressure
110
How to reduce heat loss in the OR
HME filter (Evaporation)
Warm OR table (Conductive)
Warm Hot Air (Convection)
111
What is the EBL for TURP
3-5 mL/min (usually 200-300 mL)
112
What is the formula for Cerebral Perfusion Pressure
MAP - ICP or CVP (whichever is greater)
113
How does 25% albumin affect plasma volume
Every 100mL increases plasma volume by 400 mL
114
What is the free water deficit formula?
[(Na/140)-1] x (kg x 0.6)
115
Spectrometry method that ionizes gas molecules and passes them through a magnetic field
Mass Spectometry
116
What contributes to physiologic shunting?
Thebesian veins, bronchial veins, pleural veins
117
Drugs contraindicated in patients who have Parkinson's?
Droperidol
| Metoclopramide
118
Drug that is useful in treating tremors from Parkinson's disease
Diphenhydramine (anticholinergic effect)
| scopolamine
119
Elderly response to hypercarbia and hypoxia
50% Decrease in ventilatory response too hypercarbia
| - A greater decrease in response to hypoxia
120
Signs of retrobulbar hemorrhage after a block?
dense motor block
proptosis (Bulging eye)
Palpable increase in IOP
Closing of the Lid
121
Best lead for monitoring narrow complex QRS arrhythmias
Lead II
122
How is cerebral oxygen requirement affected by temperature?
decreased by 6-7% for each degree C drop in temp
123
What is the most common cause of heparin resistance
Antithrombin III deficiency
124
Which alternate Hgb has little effect on pulse oximetry?
HgF (fetal hgb)
125
What is a normal FRC in a neonate?
70 mL
126
What is the normal RR in the neonate?
30-60 breaths/min
127
Factors indicating postoperative respiratory ventilatory insufficiency in patients with myasthenia graves?
```
Disease duration more that 6 years
Concomitant pulmonary disease
Negative inspiratory pressure < -25
VC < 4 mL/kg
Pyridostigmine dose > 750 mg/day
```
128
Epidural opioid with longest DOA and most prolonged onset
Morphine
129
Blood flow to the Liver and oxygen supply
O2 supply 50/50 hepatic artery and portal vein
| BF is 25% hepatic artery 75% portal vein
130
treatment of a patient with a carcinoid tumor includes
Octreotide
| Volume expansion and Alpha Agonist (If hypotension)
131
What are the benefits of smoking cessation
12-24 hours: Dec catecholamine levels, HR and BP: Also return of carboxyhemoglobin levels to normal
4-8 weeks: reduced chances of pulmonary complications
132
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