Exam4 Flashcards
1
Q
sole anesthesia dose:
- sufentanil (mcg/kg)
- fentanyl (mcg/kg)
A
- 10-20 mcg/kg
2. 50-100 mcg/kg
2
Q
pump flows of what mL/kg range keep MAP 50-60 mmHg?
A
50-60 mL/kg
3
Q
what is protamine dose for every 100 units of heparin?
A
1 mg
4
Q
total CO percent and mL/min:
- coronary BF
- brain
A
- 5%, 250 mL/min
2. 15%, 750 mL/min
5
Q
C/V disease is the leading cause of death at what %?
A
30%
6
Q
myocardial O2 extraction is what %?
A
70%
7
Q
cerebral vasodilation or constriction?
- increase O2
- decrease O2
- increase CO2
- decrease CO2
A
- constriction
- dilation
- dilation
- constriction
8
Q
CSF:
- total mL
- mLs made per hour
- ICP normal range
A
- 150 mL
- 30 mL/hr
- 5-15 mmHg
9
Q
what is cerebral BF fraction?
A
perfusion pressure/vascular resistance
10
Q
cerebral BF decrease what % with each degrees celsius?
A
7%
11
Q
diuretics:
- lasix mg/kg range
- lasix mg/kg range with mannitol
- mannitol mg/kg range
A
- .5 to 1 mg/kg
- .15 to .3 mg/kg
- .5 to 1 g/kg
12
Q
VA’s cause vasoconstriction or vasodilation resulting in increase or decrease cerebral BF and ICP?
A
vasodilation, increases
13
Q
what is order of VA effect on ICP?
A
HIS, D
halothane, iso, sevo, dex
14
Q
VAs:
- increase or decrease CMRO2?
- increase or decrease CPP?
A
- decrease
2. decrease
15
Q
barbiturates cause the name of what effect?
A
robin hood effect
16
Q
what is flumazenil dose? (mcg)
A
200 mcg
17
Q
what 2 IV meds increase ICP and CMRO2?
A
ketamine, succs
18
Q
ketamine increase cerebral BF what % range?
A
60-80%
19
Q
what is drug of choice for these vasospasms?
- coronary
- cerebral
A
- nitroglycerine
2. nimodipine
20
Q
put these in order of most sensitive to anesthesia to least sensitive: SSEP, visual, brainstem auditory
A
- visual
- somatosensory
- brainstem auditory
21
Q
in one word, how does fentanyl decrease amplitude and increase latency? (S)
A
slightly
22
Q
does propofol effect latency?
A
no
23
Q
what cerebral BF amount for these (mL/100g/min):
- EEG slow
- isoelectric EEG
A
- 20-25 mL/100g/min
2. 18 mL/100g/min
24
Q
what % range of neurosurgery cases have an VAE?
A
5-50%
25
what are the 9 indicators of VAE from most sensitive to least sensitive? (TD eric prays corrupt christians, elevate blood pressure)
1. TEE
2. doppler
3. ETCO2
4. PA catheter
5. CO
6. CVP
7. ECG changes
8. BP
9. precordial stethoscope
26
avoid what vent setting for pituitary surgery? (H)
hyperventilation
27
how many million ppl in north america have aneurysms?
5 million
28
what % of SAH pts?
1. transient loss of consciousness
2. severe HA
1. 45%
| 2. 85%
29
transmural pressure is the difference between what 2 pressures?
MAP and ICP
30
most neurosurgeons like to keep SBP between what mmHg range before aneurysm clipping?
120-150 mmHg
31
SAH:
1. what % of these pts have a rebleed?
2. rebleeding has what % of mortality?
1. 50%
| 2. 80%
32
cerebral vasospasm peaks at what 2 days after SAH?
4 and 9
33
triple H therapy for cerebral vasospasm:
1. what are the 3 Hs?
2. keep CVP > what?
3. keep HCT at what %?
4. keep SBP between what range?
1. HTN, hypervolemic, hemodilution
2. > 10 mmHg
3. 32%
4. 160-200 mmHg
34
avoid what lab state when treating vasospasm? (H)
hyponatremia
35
SAH anesthesia concerns:
1. intraop controlled hypotension or hypertension?
2. if proximal occlusion of a parent vessel is done, keep BP what % range above baseline to maximize collateral flow?
1. hypotension
| 2. 20-30%
36
Epilepsy:
1. what % range of general population?
2. what % range of ppl with epilepsy have intractable seizures?
3. what % range of pts with intractable seizures are surgery candidates?
1. 0.5-2%
2. 10-20%
3. 20-30%
37
Wada test:
1. what is purpose of the test?
2. what drug type is injected? (B)
3. this test is done before surgery for what condition? (E)
1. determine which side of the brain is responsible for certain vital cognitive functions (speech and memory)
2. barbiturates
3. epilepsy
38
smoking:
1. stopping what hour range before surgery decreases carboxyhemoglobin and shifts curve to the right?
2. stop what week range before surgery?
1. 12-24 hours
| 2. 4-8 weeks
39
thoracic surgery pts:
1. atelectasis, PNH and resp failure occurs in what % range of pts?
2. these account for what % range of mortality?
1. 15-20%
| 2. 3-4%
40
Bed results for these tests warrant split lung function tests:
1. PaO2 < what?
2. PaCO2 > what?
3. FVC < what %?
4. FEV1 < what number of liters?
5. FEV1/FVC ratio < %?
6. DLCO < what %?
1. 50
2. 45
3. 50%
4. 2L
5. 50%
6. 40%
41
PPO FEV1:
1. > what % are safe?
2. < what % have a 50% chance of mortality?
3. < what % will need postop ventilation?
1. >40%
2. < 40%
3. < 30%
42
PPO DLCO < what % is associated with hi M&M?
< 40%
43
PPO FEV1 x DLCO < what number is associated with hi mortality?
< 1650
44
PPO FEV1 x DLCO < 1650 is associated with what % mortality rate?
75%
45
what test is the only true significant independent predictor of complications?
PPO FEV1
46
inoperability using single lung function tests:
1. mean PAP of > what mmHg after balloon occlusion?
2. PaO2 of < what mmHg after balloon occlusion?
3. PaCO2 > what mmHg?
1. 35 mmHg
2. 45 mmHg
3. 60 mmHg
47
Lung cancer pts:
1. resections is associated with how many month survival?
2. what is mortality rate at 5 years without resection?
1. 18 months
| 2. 100%
48
absolute CI for pulmonary resection if PPO VO2 is less than what mL/kg/min?
< 10 mL/kg/min
49
increased risk of surgery if O2 saturation drops more than what % during exercise?
>4%
50
Obstructive pulmonary disease:
1. FEV1/FVC < or > 0.7?
2. what 2 diseases? (A, C)
1. <0.7
| 2. asthma, COPD
51
restrictive pulmonary disease:
1. what 3 pulm conditions? (F, P, E)
2. disorders of what wall? (C)
3. what type of diseases? (NM)
4. FEV1/FVC < or > 0.7?
1. fibrosis, pneumo, edema
2. chest wall
3. neuromuscular diseases
4. >0.7
52
what are 4 treatable conditions of COPD? (A, B, I, E)
1. atelectasis
2. bronchospasm
3. infection
4. edema
53
does intrathoracic tumor have inhaled or exhaled obstruction?
exhaled obstruction
54
does extrathoracic tumor have inhaled or exhaled obstruction?
inhaled obstruction
55
what does the intrathoracic tumor loop look like?
diamond
56
what does the extrathoracic tumor loop look like?
sailboat
57
what % of lung cancer pts develop paraneoplastic tumor?
10%
58
what % range of lung cancer pts develop lambert eaton syndrome?
1-2%
59
DLT is placed in which side not matter what surgery?
left side
60
adult trachea:
1. begins at what cervical level?
2. bifurcates at what thoracic level range?
1. C6
| 2. T4-5
61
R and L lungs:
1. angle to R bronchus?
2. angle to L bronchus?
3. R upper lobe from carina? (cm)
4. L upper lobe from carina? (cm)
1. 25 degrees
2. 45 degrees
3. 2.5 cm
4. 5 cm
62
DLT is what cm at teeth?
29 cm
63
what mL range of air in cuff?
1. tracheal cuff?
2. bronchial cuff?
1. 5-10 mL
| 2. 1-2 mL
64
confirming DLT placement:
1. put these in order of performed: clamp tracheal and listen, inflate tracheal and listen, clamp bronchial and listen, inflate bronchial and listen.
2. last step is direct observation with what? (B)
1. inflate tracheal & listen, inflate bronchial & listen, clamp tracheal & listen
2. bronchoscope
65
One lung ventilation guidelines:
1. what TV range of mL/kg?
2. keep plateau pressure < what cm H2O?
3. keep FiO2 at what % range?
4. adjust RR to keep ETCO2 at what mmHg?
1. 5-8 mL/kg
2. < 25 cm H2O
3. 80-100%
4. 40 mmHg
66
what in the airway is the only absolute CI for a DLT? (LM)
luminal mass
67
which VA inhibits HPV and exacerbates pulm HTN?
N2O
68
avoid what 3 MRs as they cause histamine release, which can cause bronchospasm? (SAM)
succs, atracurium, mivacurium
69
DLT size range:
1. women
2. men
1. 35-37
| 2. 39-41
70
PPO FEV1 extubation:
1. extubate in the OR if > what %?
2. extubate based on other tests if between what % range?
3. used staged weaning if < what %?
4. consider extubation if > what % and with a thoracic epidural?
1. > 40%
2. 30-40%
3. < 30%
4. > 20%
71
what thoracic epidural range for post-thoracotomy pain?
T7-8
72
extubation criteria in OR:
1. SpO2 > what % with FiO2 < what %?
2. RR in what range?
3. Tv > what mL/kg?
4. MV < what L?
5. NIF > negative cmH2O?
6. head lift for how many seconds?
1. 95% at 40% FiO2
2. 8-30
3. > 5 mL/kg
4. < 10 L
5. -20 cm H2O
6. 5 seconds
73
for mediastinoscopy, what arm should the A line and pulse ox be on?
right arm
74
precedex;
1. load dose is what mcg/kg over 10 min
2. maintenance dose is what mcg/kg/hr range
3. goal is ramsay score greater or equal to what?
4. moderate reduction in what 2 vital signs?
5. what is half life in minutes?
6. clearance may be lower in pts with what organ disease?
1. 1 mcg/kg
2. 0.5-0.7 mcg/kg/hr
3. 2
4. HR, BP
5. 6 minutes
6. liver
75
what do these voices sound like?
1. SLN damage (W, H)
2. unilateral RLN damage (H)
3. bilateral RLN damage (A)
1. weak, husky
2. hoarse
3. aphonia
76
are the VC's paralyzed with bilateral RLN damage?
yes
77
oral numbing:
1. how many mL of 4% lidocaine nebulizer?
2. how many mL of 4 % lidocaine solution gargled?
1. 3 mL
| 2. 2 mL
78
nasal numbing:
1. pledgets remain in contact for what minute range?
2. bilateral block is done to block what fibers? (S)
1. 5-7 minutes
| 2. sphenopalatine
79
which LA has a SE of methemoglobinemia?
benzocaine
80
cocaine:
1. max dose (mg)
2. dose mg/kg
3. DOA minute range
1. 100 mg
2. 1.5 mg/kg
3. 30-60 minutes
81
benzocaine:
1. max dose (mg)
2. DOA minute range
1. 200 mg
| 2. 5-10 min
82
what mg/kg range of methylene blue over 5 minutes for methemoglobinemia treatment?
1-2 mg/kg
83
lidocaine max mg/kg:
1. without epi?
2. with epi?
1. 4 mg/kg
| 2. 7 mg/kg
84
lidocaine:
1. what is toxic level? (mcg/mL)
2. caution in pts with what organ disease?
1. 5 mcg/mL
| 2. liver
85
for an SLN block, lidocaine is injected 1 cm above or below the greater cornu of the hyoid bone?
below
86
trans-tracheal block:
1. needle goes thru what membrane?
2. how many mL and what % of lido?
1. cricothyroid membrane
| 2. 4 mL of 4%
87
fiberoptic scope has 2 bundles of what fiber range?
10,000 to 15,000
88
what branch of the glossopharyngeal nerve is blocked? (L)
lingual
89
fiberoptic intubation:
1. easier on awake or asleep pts?
2. put what over eyes to prevent corneal abrasions?
3. what name of airway is placed to facilitate intubation? (OA)
4. place ETT what cm range above the carina?
5. what 3 blocks are performed for a nasal FOI?
1. awake
2. blue towels
3. ovassapian airway
4. 3-4 cm
5. nasal, SLN, trans-tracheal
90
what are the 9 layers for spinal placement? (S,F,S,I,L,D,S,A,S)
1. skin
2. fat
3. supraspinous ligament
4. interspinous ligament
5. ligamentum flavum
6. dura mater
7. subdural space
8. arachnoid mater
9. subarachnoid space
91
autonomic block extends above or below sensory block what range of segments?
above by 2-3 segments
92
epidural space width at these levels (mm, range):
1. lower cervical
2. thoracic
3. lumbar
1. 1.5-2 mm
2. 3-5 mm
3. 5-6 mm
93
optimal epidural catheter is how many cm into epidural space?
4 cm
94
length to epidural space:
1. average cm
2. range of cm
1. 5 cm
| 2. 2.5-8 cm
95
what is the max mL of LA per segment?
1.6 mL
96
Decreases in LA:
1. elderly and neonates need what % decrease?
2. pregnant women need what % decrease?
1. 50%
| 2. 30%
97
how many mL of bicarb?
1. per 10 mL of bupivacaine
2. per 10 mL of lidocaine
1. .1 mL
| 2. 1 mL
98
which LA can cause resistant VF?
bupivacaine
99
what are the easiest to hardest to block? (S,P,T,P,T,P,M)
1. sympathetic
2. pain
3. temp
4. proprioception
5. touch
6. pressure
7. motor
100
anticoags and neuraxial blocks:
1. is mindose heparin a CI?
2. able perform block how many hours after low dose LMWH?
3. able to perform block how many hours after hi dose LMWH?
4. stop warfarin for what day range?
5. stop IV heparin for how many hours before performing?
6. you are able to give LMWH how many hours after catheter removal?
7. you are able to give heparin how many hours after placement and how many hours after removal?
8. pause heparin what hour range before epidural catheter removal?
1. no
2. 12 hours
3. 24 hours
4. 3-5 days
5. 4 hours
6. 2 hours
7. 1 hour
8. 2-4 hours
101
bier block:
1. is proximal or distal cuff inflated first?
2. tourniquet must be inflated for how many minutes?
3. what is the max hours of inflation?
4. what is minute range before tourniquet pain?
5. what is mL range of 2% lido?
6. what is mL range of 0.5% lido?
1. proximal
2. 20 minutes
3. 2 hours
4. 45-60 minutes
5. 12-15 mL
6. 30-40 mL
102
brachial plexus:
1. what are the 4 approaches? (A,I,S,I)
2. what is the LA mL range?
1. axillary, interscalene, supraclavicular, infraclavicular
| 2. 20-40 mL
103
interscalene block landmarks:
1. what head?
2. what cartilage? (C)
3. groove between what 2 muscles?
1. clavicular head of sternocleidomastoid
2. cricoid cartilage
3. anterior and middle scalene muscles
104
should the supraclavicular block be used for surgeries involving the shoulder?
no
105
What block for these surgeries:
1. shoulder and upper arm
2. just upper arm
3. hand or forearm
1. interscalene
2. supraclavicular
3. axillary
106
supraclavicular landmarks:
1. midline of what bone?
2. what groove?
1. clavicle
| 2. interscalene
107
what is the best lead to detect an MI?
V5
108
V5 detects what % of MIs?
75%
109
what is the % mortality rate of symptomatic heart failure?
45%
110
what causes release of atria natriuretic peptide? (VO)
volume overload
111
what causes release of B-type natriuretic peptide? (WS)
wall stress
112
what are the 7 steps of CPB? (H, R, P, O, H, F, A)
1. heart
2. reservoir
3. pump
4. oxygenator
5. heat
6. filter
7. artery
113
what is myocardial temp goal range in celsius?
8-10 degrees C
114
goals of AS:
1. maintain what rhythm?
2. maintain adequate volume where?
1. sinus rhythm
| 2. ventricle
115
what is the normal LV outflow tract diameter in cm?
2.2 cm
