Exam 1 Flashcards
(204 cards)
1
Q
How is BMI in Metric calculated?
A
BMI= kg / m2 [Weight (Kg) / Height (m2)]
2
Q
How is BMI calculated in the inferior Imperial way?
A
703 x lbs / in2 [703 x weight / height (in2)]
3
Q
A normal BMI range is?
A
18.5 to 24.9
4
Q
An obese BMI is?
A
30.0 & above
5
Q
BMI can be used to determine?
A
- Fluid volume requirement,
- acceptable blood loss,
- drug dosage,
- adequate u/o
6
Q
What Pre-op intervention can be done for someone with sickle cell?
A
Admit day before to hydrate & possibly pre medicate as it is very hard to control their pain.
7
Q
What is G6PD deficiency?
A
Disregard
8
Q
What should be avoided in Pts with neuromuscular disorders?
A
NMJB
9
Q
How does anesthesia affect seizure meds?
A
It will reduce half-life of the seizure meds
10
Q
What should be watched in someone with Raynaud’s?
A
Their BP, may do poorly in OR if BP is low
11
Q
Blood glucose swings is a sign of what?
A
Poor nutrition
12
Q
Examples of High risk procedures are?
A
- Aortic,
- major vascular Sx
- peripheral vascular
13
Q
Examples of Intermediate risk procedures are?
A
- Intra-Abd
- Intra-thoracic Sx,
- Carotid Sx,
- Head & neck Sx
14
Q
What all results in 1 point given in the Revised cardiac Index scale?
A
- High-risk Sx (intraperitoneal, intrathoracic, or suprainguinal vascular Sx)
- ischemic heart disease
- CHF
- cerebrovascular disease
- DM requiring insulin
- Creatinine >2.0mg/dL
15
Q
A score of 3 on the Revised Cardiac Risk Index Score correlates to?
A
A 5.4% risk of major cardiac events.
16
Q
What does the MET scale evaluate & what is the cutoff?
A
- Cadiopulmonary fitness & if further testing is necessary.
- Cutoff >4 METs (Want >4)
- <3 means to cancel Sx to run more tests
17
Q
What is an urgent surgery?
A
Life or limb at risk if no surgery is done within 6-24hrs
18
Q
How to asses cardiopulmonary function in a bedridden Pt?
A
With a chemical stress test.
19
Q
What is ASA I?
A
A normal healthy Pt, no or minimal EtOH
20
Q
What defines ASA II?
A
- Mild systemic disease without functional limitations.
- Social drinker
- pregnancy
- BMI 30-40
- controlled DM
- mild lung disease
21
Q
What defines ASA III?
A
- Severe systemic disease. w/ functional limitations,
- Poorly controlled DM, HTN or COPD,
- Morbid obesity
- Active hepatitis
- EtOH abuse
- PPM
- CHF
- ESRD
- Hx of MI, CVA, TIA
- CAD/stents (>3mos)
- Premature infant postconceptual age.
22
Q
What defines ASA IV?
A
- Severe systemic disease that is constant threat to life.
- Recent MI, CVA, TIA, CAD/stents
- Severe valve dysfunction
- Severe CHF
- Sepsis
- DIC
- ESRD not on HD
- ARDS
23
Q
Define ASA V?
A
- A Pt that would die without Sx.
- Ruptured aneurysm
- Massive trauma
- Intracranial bleed
- Ischemic bowel in face of significant cardiac pathology or MODS
24
Q
Define ASA VI?
A
Declared brain-dead. Organ donation
25
When to get CBC pre-op?
- Hx of bleeding
- Hematology disorder
- Anti-coag therapy
- Poor nutrition
- ASA III
- All major Sx
26
When to get pre-op renal panel?
- DM
- HTN
- Cardiac disease
- N/V/D
- Renal disease
- Fluid overload
- ASA III & IV undergoing intermediate Sx
- ASA II, III, IV undergoing major Sx
27
What is considered minimal sedation?
Drowsy, able to talk
28
What is the difference between regional & local anesthesia?
- Regional numbs large area (epidural, nerve block)
- Local numbs small area (biopsy)
29
What are the most common allergies?
- Rocuronium
- Latex (spina bifida)
- CHG/Iodine
- Abx
- Adhesives
- Opioids
30
What can be done in someone with an Abx allergy?
Give a test dose (1/10th)
31
In what kind of allergy are PCN/cephalosporin Abx avoided?
True IgE-mediated allergy
32
How can Amides & Esters be identified?
- Amides have 2 I’s in their name
- Esters have 1 I in their name.
33
Which antihypertensive medications should be d/c’ed before Sx & why?
- ACEi & ARB’s
- May cause severe hypotension under anesthesia.
34
What medication should be d/c’ed 4 weeks prior to Sx & why?
- Oral contraceptives
- High risk for post-op venous thrombosis
35
What interaction is there between NMJB’s & anticonvulsants?
Anticonvulsants decrease the lifespan of NMJB’s
36
What 2 medications should be avoided in Sx in someone that takes MAOI’s?
Meperidine & ephedrine
37
When should topical medications be discontinued prior to Sx?
24hrs
38
What diuretic should be d/c’ed & when prior to Sx?
Thiazides & 24hrs
39
When is it not okay to d/c P2Y12 inhibitors?
In someone that is within the first 6 months of taking drug eluting stents.
40
When should Post-menstrual HRT be d/c’ed prior to Sx?
4 weeks
41
What should a type 1 diabetic do with their insulin regimen prior to Sx?
- Take 1/3 of their usual dose the morning of Sx
- Continue basal rate if infusion pump present
42
What should a type 2 diabetic do with their insulin regimen prior to Sx?
Take none or up to half of a long-acting the day of Sx.
43
What & how much stress dose medication is given?
100mg hydrocortisone q8hr for up to 24-48hrs.
44
What are the NPO times for full meal, light meal, breast milk, & clear liquids?
8hrs, 6hrs, 4hrs, & 2hrs
45
When can tube feeds be continued?
With a Dobhoff unless it is a abdominal case.
46
What is Mendelson syndrome & what are the factors?
- Increased risk of aspiration.
- >25cc gastric residual & pH <2.5
47
What are some aspiration prophylactic measures?
- Decrease gastric volume
- Increase gastric pH (sodium citrate),
- H-2 receptor antagonist
- PPI’s
- Dopamine-2 antagonist.
48
H-2 receptor antagonists like Pepcid & PPI’s do what?
Increase gastric pH & decrease gastric acid secretion
49
Who is at risk for pulmonary aspiration?
- Pregnancy
- DM
- Significant opioid users
- BMI >40
- Emergent Sx
- Any esophagus or abdominal issue Pt
50
According to the Apfel score, who is at risk for PONV?
- Female
- HX of PONV/motion sickness
- Nonsmoking
- Post-op opioids
51
For someone with an Apfel score of 3-4 should receive what considerations?
- Avoid general anesthesia
- Propofol
- Minimize opioids
- Prevent 3 drugs from different classes.
52
For a Pre-op Pt currently on Vanc or fluoroquinolone should receive their Abx when?
2hrs before incision
53
What anesthesia considerations are made in someone taking Echinacea?
It reduces effectiveness of immunosuppressants.
54
What anesthesia considerations are made in someone taking Ephedra?
- Risk of MI
- Arrhythmia
- Hemodynamic instability
- D/C 24hrs pre-op
55
What anesthesia considerations are made in someone taking garlic (ajo)?
Inhibits plt aggregation. D/c 7 days prior to Sx
56
What anesthesia considerations are made in someone taking ginger?
Increased risk of bleeding
57
What anesthesia considerations are made in someone taking Ginko?
Increased risk of bleeding. D/C 36hrs before Sx.
58
What anesthesia considerations are made in someone taking Ginseng?
- Hypoglycemia
- Increased bleeding
- Decrease effect of Warfarin. D/c 7days prior to Sx.
59
What anesthesia considerations are made in someone taking Green tea?
Increased risk of bleeding
60
What anesthesia considerations are made in someone taking Kava?
Increase sedative effects of anesthetics
61
What anesthesia considerations are made in someone taking Saw palmetto?
Increased risk of bleeding.
62
What anesthesia considerations are made in someone taking St John’s?
- Induction of CYP450
- Affects benzos, CCB’s
- Delayed emergence.
63
What anesthesia considerations are made in someone taking valerian?
- Increased sedation effects
- Acute benzo withdrawal
- Increased anesthetic use with long-term use.
64
Scopolamine patch should not be used in what kind of Pt?
Narrow-angle glaucoma, confused Pts
65
What N/V medication is given after induction & what can it cause?
Dexamethasone. Can cause increased blood glucose
66
When are Abx re-dosed in the OR?
When the Sx lasts >4hrs
67
What is the audible frequency range for humans?
20Hz – 20,000Hz
68
What range do ultrasounds operate in?
2 – 18 megahertz
69
What generates & receives the ultrasound waves?
Piezoelectric crystal
70
What frequency do linear, curved, & phased ultrasounds use?
High frequency, medium to low, & medium to low frequency.
71
What are Linear US used for?
Superficial imaging such as vessels, muscle, tendon, breast, thyroid.
72
What are curved US used for?
Anatomy needing wider & deeper field of view such as abdominal
73
What are phased US used for?
Smaller footprint allows for scanning small spaces such as between ribs, cardiac.
74
What frequency is used for scanning superficial structures such as tendons?
High frequencies (10MHz or higher)
75
What frequency is used for scanning abdominal aorta?
Low frequency (4MHz or less)
76
Vibration travels faster through water than air?
True, vibration travels fastest thru bone.
77
The higher the density, the___ the speed, & the higher the stiffness, the___ the speed?
Lower & higher
78
What is the aperture size?
The number of activated piezoelectric elements
79
What can improve the lateral resolution with curved transducers?
Adjusting the focal zone
80
Phased US transducers produce what kind of field of view?
A cone shaped view
81
What is the US Focal Zone?
Point at which the US beam is narrowest & beam intensity the greatest. The Focal zone is the area around the focal point. Lateral resolution is best within this zone.
82
What is the Fraunhofer Zone?
Zone distal to focal point. The beam diverges & creates gaps within the beam. Higher frequency elements produce less divergence. Lateral resolution is greatly reduced.
83
What is the Fresnal zone?
Zone proximal to focal point. Beam is as wide as the transducer. Lateral resolution in this area is good.
84
Higher frequency= ___ near field zone, & lower frequency= ___ near field zone?
Longer & shorter
85
Impedance determines what?
Whether sound waves reflect, refract or attenuate.
86
Air will appear ___ & ___ on ultrasound & tissue posterior to air will be ___?
Bright & reflect. Unable to be visualized.
87
What reduces impedance and reflection?
Ultrasound gel
88
Rank the following from most to least reflective; bone, air, muscle, liver?
Air, bone, liver, muscle
89
What is mirror artifact?
Sound wave travel through a medium then encounter a smooth strong interface making the distal part appear the same as the proximal medium.
90
What is refraction & how can it be overcome?
Sound waves change direction when waves strike two adjacent mediums with slightly different impedance. Overcome it by tilting or change angle with pushing the probe.
91
What is edge artifact?
Beam strikes medium at a non-normal incidence & is redirected away creating a shadow of reduced intensity.
92
What is attenuation & what frequency is more likely to be affected?
- Sound wave amplitude & intensity decreases as it travels thru tissue.
- Higher frequencies are affected to a higher degree.
93
What is absorption & which frequency is affected more?
- Sound wave loses energy to heat as it travels through a medium.
- Higher frequencies have higher absorption.
94
What is Echogenicity?
The ability to reflect or transmit US waves in the context of surrounding tissues (different levels of contrast).
95
What is Anechoic & what structures are usually it?
- The black structures (no internal echoes).
- Typically things like blood vessels, cysts, gallbladder, urinary bladder, & anterior chamber of the eye.
96
What is & what structures are Hypoechoic?
- Structures appear darker than surroundings (give off fewer echoes).
- Increased density tissues, such as fibrous masses, nerves, & fat?
97
What is & what structures are Hyperechoic?
Bright structures (more echoes & lower density), such as fatty tumors, bone.
98
What is Isoechoic?
Two structures that give off similar echoes relative to another.
99
When does shadowing occur?
When waves encounter a very high attenuation coefficient structure, such as bone or solids. The distal part will appear black.
100
What is posterior acoustic enhancement?
US waves travel through very low attenuation (fluid structures) causing an increased brightness of posterior echoes.
101
What is reverberation & when is it really useful?
US waves hit a highly reflective surface (needle) causing A-lines. It is really useful in lung imaging. The proximal A-lines travel evenly through the air-filled regions of the lung.
102
What refers to B-Mode?
Echogenicity
103
2D/B-Mode is useful for?
For structural information. It uses different shades of gray.
104
What is M-Mode on ultrasounds used for?
- Calculating fetal heart rate
- cardiac imaging
- lung sliding (rule out pneumothorax).
105
What is Positive/Doppler Shift?
- US waves bounce off RBC’s moving towards the transducer, echoes are compressed & perceived as high frequency.
- Display color will be red but does not signify artery or vein just movement towards probe.
106
What position will result in the best pulse wave doppler image?
Parallel with the flow direction.
107
Sliding is moving along the ___ axis & sweeping is moving along the ___ axis?
Long & short
108
In short-axis, the structure of interest is viewed in a ___ plane, while in long-axis the structure of interest is viewed in a___ plane?
Transverse & longitudal
109
Out of plane the needle is inserted ____ to the image & in plane the needle is inserted ___to the image?
Perpendicular & parallel
110
In what leads will the P wave be positive?
Leads I, II, aVF, V4-V6
111
A retrograde P-wave means what?
A junctional rhythm with the signal coming from the AV node
112
The T-wave will positive in what leads?
Leads I, II, V3-V6
113
Halothane & enflurane can cause what?
Sensitive myocardium leading to arrhythmias
114
Sevoflurane can cause _____ in infants?
Bradycardia
115
Desflurane may cause ____ during induction?
Prolonged QT
116
Concentrated intravascular local anesthetic can cause ____ & is treated with____?
Asystole & lipid rescue
117
What is sometimes masked intra-op & presents post-op with HTN, tachycardia or both?
Catecholamine excess
118
Pt’s using cocaine are more likely to what intra-op?
Bleed
119
Pt’s using meth are likely to what intra-op?
Go hypotensive. They are chronically hypertensive.
120
What does a Pt’s temp have to be to go to PACU?
96 degrees
121
What is anthropometry?
Study of measurements & proportions of the human body
122
What is micrognathia?
Undersized lower jaw.
123
Compare axillary vs core temp.
Axillary will read 1 degree Fahrenheit less
124
Which NMJB should not be given to bedridden Pt’s?
Succinylcholine
125
When is mediated or indirect percussion used?
To evaluate the abdomen or thorax. Strike fingers of one hand with other.
126
When is Immediate percussion used?
To evaluate the sinus or an infant thorax. Strike surface directly with fingers
127
When is fist percussion used?
To evaluate the back and kidneys for tenderness.
128
A high pitched, drum-like sound during percussion is indicative of?
Air containing space, enclosed area, gastric air bubble
129
A long, hollow, low pitched sound during percussion is indicative of?
Normal lungs
130
A very loud & low booming sound during percussion is indicative of?
Emphysematous lungs
131
A thud-like, high pitched percussion is indicative of which organ?
Liver
132
A short, high pitched, flat sound percussion is indicative of which organ?
Muscle
133
What is Gilbert’s syndrome?
This is an inherited condition that impairs the ability of enzymes to process the excretion of bile.
134
What is Cholestasis?
This interrupts the flow of bile from the liver. The bile containing conjugated bilirubin remains in the liver instead of being excreted.
135
What is Hemolytic anemia?
The production of bilirubin increases when large quantities of red blood cells are broken down.
136
What happens in inflammation of the bile duct?
This can prevent the secretion of bile and removal of bilirubin, causing jaundice.
137
What happens in acute inflammation of the liver?
This may impair the ability of the liver to conjugate and secrete bilirubin, resulting in a buildup.
138
What is Vitiligo?
An autoimmune disorder in which the systems in the body that fight off infection begin to fight off the healthy cells (melanocytes). Black & white skin)
139
Ecchymosis can be caused by what?
- Sinus infection
- cocaine use
- spontaneous bleeding
- skull fx
140
What is Koilonychia, also known as spoon nails?
Nail disease that can be a sign of hypochromic anemia, especially iron-deficiency anemia. It refers to abnormally thin nails (usually of the hand) which have lost their convexity, becoming flat or even concave in shape. In a sense, koilonychia is the opposite of nail clubbing. In early stages nails may be brittle and chip or break easily.
141
What is Paronychia?
- Inflammation of the skin around the nail, which can occur suddenly
- It is usually due to the bacterium Staphylococcus aureus
- Gradually caused by the fungus Candida albicans.
142
Someone with a shampoo allergy might also be allergic to?
CHG, chloraprep, etc.
143
What is anisocoria?
A notable difference in pupil size between the two eyes.
144
What is Horner’s syndrome?
- Constellation of clinical signs, the triad of ptosis, miosis, & anhidrosis.
- Results from a lesion to the sympathetic pathway that supply the head and neck region.
145
What is the treatment for a sty?
Warm moist towel, helps increase perfusion and unclog the duct.
146
How does Narcan affect the pupils?
Narcan can make pupils slow to react. Even unevenly.
147
What is the dose & interval for atropine in adult bradycardia?
1mg q3-5mins max 3mg
148
What is the treatment for beta blocker induced bradycardia?
`Glucagon
149
What is the treatment for CCB induced bradycardia?
Calcium
150
At what ETCO2 reading does a cardiac arrest pt perfuse adequately?
>15 mmHg
151
What are the lidocaine doses for an adult cardiac arrest?
- First dose: 1 -1.5 mg/kg.
- 2nd dose: 0.5 – 0.75 mg/kg
152
What are the 3 medications for stable wide complex tachycardia?
- Amio: bolus 150mg over 10mins then infusion.
- Procainamide: 20-15 mg/min (start w/ 20 mg/min & titrate until
arrhythmia is suppressed or hypotension occurs or QRS widens
>50%).
- Sotalol: 100 mg over 5mins (avoid in long QT).
153
What is the treatment for magnesium OD in PIH?
Calcium or gluconate
154
What are the causes for cardiac arrest in pregnancy?
- (A)nesthetic
- (B)leeding (prone to DIC)
- (C)ardiovascular
- (D)rugs
- (E)mbolic
- (F)ever
- (G)eneral
- (H)TN
155
What is the Epi dose in pediatric cardiac arrest (IV & ETT)?
- IV: 0.01 mg/kg
- ETT: 0.1 mg/kg
156
What is the Amio dose for pediatric cardiac arrest?
5mg/kg up to 3 doses
157
What is the lidocaine dose for pediatric cardiac arrest?
1mg/kg loading
158
What is the atropine dose in pediatric bradycardia?
0.02 mg/kg q3-5mins
159
What is the adenosine dose for pediatric tachycardia?
0.1 mg/kg
160
What are the neonatal target SpO2 1min & 5mins post birth?
- 1min= 60-65%
- 5mins= 80-85%
161
When should Epi be given in neonatal resuscitation?
If HR <60 persists.
162
When is neonatal resuscitation started?
If apneic or HR <100.
163
How are Celsius convert to Fahrenheit & vice versa?
- Take Celsius temp multiply it by 1.8 & add 32.
- Take Fahrenheit temp, subtract 32 and multiply by 5/9th.
164
What position is recommended for EKG lead placement?
Supine
165
What is axis deviation used for?
- To diagnose hemiblocks
- Calling VT
- Identify possible complications
166
What axis would result from an anterior hemiblock?
Pathological Left axis (-40 to -90degrees)
167
What axis would result from a posterior hemiblock?
Right axis (90 to 180degrees)
168
What axis would result from a ventricular origin rhythm?
Extreme right axis
169
What will the QRS, in Leads I, II, III look like in an extreme right axis?
Negative like a V in all 3.
170
What Lead is used for BBB & what other criteria is important?
- V1 (MCL-1)
- QRS must be at least .12sec wide
171
What will the QRS, in Leads I, II, III look like in a pathological left axis?
- Lead I= ^
- Lead II & III= negative V
172
What meds are not given to someone with a RBBB + anterior hemiblock?
Lidocaine & procainamide
173
What block is at high risk for LAD occlusion?
RBBB + posterior hemiblock
174
What part of the heart is the best seen on a 3 lead EKG?
LV inferior wall
175
The LAD supplies which structures?
- LV anterior wall
- septal wall
- Bundle of His
- BB
176
Someone with an occlusion in the LAD is at risk for?
- Decreased systemic perfusion
- myocardial rupture
- hypotension
177
The Circumflex supplies which structures?
- LV lateral & posterior walls
- SA (40%) & AV (10%) nodes
178
Chest pain on exertion refers to what percentage of occlusion?
70 – 85%
179
What is ischemia & at what time does it start?
- Transient reduction in blood flow to the myocardium
- Begins to form in 30mins
180
Where will reciprocal changes be in an inferior MI & which leads will have ST depression?
- Reciprocal in V1 – V3
- ST depression in Lead I & aVL
181
ST depression can indicate what else besides infarcts?
- Subendocardial injury
- Drug or electrolyte problems
182
At what size is a Q wave pathological & what does it mean?
- >40 ms wide or 1/3 depth of R wave
- Means necrotic tissue is present
183
Leads I & aVL refer to what part of the heart?
High lateral
184
The circumflex correlates to which leads & where would reciprocal changes be?
- V5, V6, Lead I
- Reciprocal in aVL Leads II, III, aVF
185
The LAD correlates to which leads & where would reciprocal changes be?
- V1 – V4
- Reciprocal in II, III, aVF
186
The RCA correlates to which leads in a normal, posterior & RV EKG?
- Normal EKG= inferior II, III, aVF
- Posterior EKG= V8, V9, V1.
- RV EKG= V4r
187
What reciprocal changes would be seen with a posterior AMI?
ST depression in V1 – V4
188
Inferior MI’s may present with what kind of symptoms?
- Nausea
- Abd referred pain
- Bradycardia
- Hypotension
189
An anterior wall MI can lead to?
- CHB, VT, or VF
- Hemiblocks
- Anterorseptal or anterolateral MI’s
190
Besides PCI, what is the treatment for anterior wall MI’s?
- Nitrates IV
- No fluid bolus, use fluids cautiously
191
What reciprocal changes will be seen with LV hypertrophy?
None
192
What position will someone with pericarditis feel best in?
Leaning forward
193
How & what is the Weber’s test used for?
- Strike the tuning fork and press base on top of Pt’s head.
- Ask where they hear the sound the loudest.
194
How is the Rinne’s test performed & what is it used for?
- Used for testing for hearing loss (air vs bone conduction).
- Strike tuning for on your thigh then hold it perpendicular to Pt’s ear, 1cm away. Then strike thigh again and hold base of tuning fork firmly against bone surrounding the ear.
- Ask Pt which sound was louder.
195
What can inhaled nitrous lead to in nasal procedures?
Air trapping
196
Besides the eyes & skin what is a good site to check for jaundice?
Buccal mucosa
197
A bright red tongue is an indication for what?
Vitamin B12 or niacin deficiency
198
What is an indication of cherry-colored lips?
Carbon-monoxide poisoning
199
What are spongy gums indicative of?
Vitamin C deficiency
200
What is Leukoplakia?
Thick white patches on gums due to smoking & EtOH
201
What does the Romberg’s test assess?
Perception
202
How do you assess arm flexion at the elbow?
- Identify biceps tendon by flexing against resistance
- Then place arm @ 90 degrees
- Place finger on tendon & strike it.
203
How do you assess extension at elbow?
1) Flex arm at elbow,
2) Hold arm across chest or hold upper arm horizontally
3) Strike tendon just above elbow
204
What herbs/supplements carry increased risks for bleeding?
Saw Palmetto & anything starts with a G.
